Provider Demographics
NPI:1831654417
Name:SHIN, SAMUEL YOUNG (MA)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:YOUNG
Last Name:SHIN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N MAR VISTA AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1428
Mailing Address - Country:US
Mailing Address - Phone:505-403-6035
Mailing Address - Fax:
Practice Address - Street 1:112 N MAR VISTA AVE APT 9
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1428
Practice Address - Country:US
Practice Address - Phone:505-403-6035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health