Provider Demographics
NPI:1740654078
Name:SHIN, BENJAMIN SEUNGCHUL (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:SEUNGCHUL
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 1:520 S LA FAYETTE PARK PL STE 300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-5400
Mailing Address - Country:US
Mailing Address - Phone:213-252-2100
Mailing Address - Fax:213-252-2199
Practice Address - Street 1:520 S LA FAYETTE PARK PL STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-5400
Practice Address - Country:US
Practice Address - Phone:213-252-2100
Practice Address - Fax:213-252-2199
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.0717012084P0800X
CA1743902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry