Provider Demographics
NPI:1881449338
Name:SHIN, JANE HAE SOO (DO MS)
Entity type:Individual
Prefix:
First Name:JANE HAE SOO
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:DO MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20000 N 57TH AVE RM H210
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6877
Mailing Address - Country:US
Mailing Address - Phone:213-503-6522
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST STE 8C
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-4275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program