Provider Demographics
NPI:1649441767
Name:SHIN, JEAN JUNGSOON (LAC, PHD)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:JUNGSOON
Last Name:SHIN
Suffix:
Gender:F
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21520 SOUTH PIONEER BLVD.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HAWAIIAN GARDEN
Mailing Address - State:CA
Mailing Address - Zip Code:90716
Mailing Address - Country:US
Mailing Address - Phone:562-809-0351
Mailing Address - Fax:562-809-0372
Practice Address - Street 1:21520 PIONEER BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-2603
Practice Address - Country:US
Practice Address - Phone:562-809-0351
Practice Address - Fax:562-809-0372
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10733171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist