Provider Demographics
NPI:1912450214
Name:SHAHIN, TINA (DPM)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:SHAHIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 S BUENA VISTA ST STE 315
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4556
Mailing Address - Country:US
Mailing Address - Phone:818-848-5587
Mailing Address - Fax:
Practice Address - Street 1:191 S BUENA VISTA ST STE 315
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4556
Practice Address - Country:US
Practice Address - Phone:818-848-5587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH59.000648213ES0103X
CAE5522213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery