Provider Demographics
NPI:1770888976
Name:SHIN, HYE K (LAC)
Entity type:Individual
Prefix:
First Name:HYE
Middle Name:K
Last Name:SHIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:SHIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:749 GARLAND DR
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-3604
Mailing Address - Country:US
Mailing Address - Phone:650-324-0645
Mailing Address - Fax:
Practice Address - Street 1:39189 CEDAR BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5001
Practice Address - Country:US
Practice Address - Phone:510-505-9885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13776171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist