Provider Demographics
NPI:1811354566
Name:SHIN, HYEJIN
Entity type:Individual
Prefix:
First Name:HYEJIN
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14200 CULVER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-0350
Mailing Address - Country:US
Mailing Address - Phone:949-293-5994
Mailing Address - Fax:714-422-0338
Practice Address - Street 1:14200 CULVER DR STE 210
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-0350
Practice Address - Country:US
Practice Address - Phone:949-293-5994
Practice Address - Fax:714-422-0338
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AC11296171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist