Provider Demographics
NPI:1801090188
Name:SHIN, DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:SHIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1930 WILSHIRE BLVD
Mailing Address - Street 2:804
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3605
Mailing Address - Country:US
Mailing Address - Phone:213-623-5125
Mailing Address - Fax:310-496-0183
Practice Address - Street 1:1930 WILSHIRE BLVD
Practice Address - Street 2:804
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3605
Practice Address - Country:US
Practice Address - Phone:213-623-5125
Practice Address - Fax:310-496-0183
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75155207L00000X
CAG075155207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology