Provider Demographics
NPI:1295713816
Name:SHIN, DANIEL Y (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:Y
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8628 E IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242
Mailing Address - Country:US
Mailing Address - Phone:562-904-0540
Mailing Address - Fax:562-904-0544
Practice Address - Street 1:8628 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242
Practice Address - Country:US
Practice Address - Phone:562-904-0540
Practice Address - Fax:562-904-0544
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43329208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHW11998DMedicare PIN
CAEL210ZMedicare PIN
E27136Medicare UPIN
CAHW11998EMedicare PIN