Provider Demographics
NPI:1669242715
Name:SHIN, DAJIN (ND)
Entity type:Individual
Prefix:
First Name:DAJIN
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SANDLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-6908
Mailing Address - Country:US
Mailing Address - Phone:213-440-0055
Mailing Address - Fax:
Practice Address - Street 1:1001 SANDLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-6908
Practice Address - Country:US
Practice Address - Phone:213-440-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND1467175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath