Provider Demographics
NPI:1952161572
Name:SHINN, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:SHINN
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 1:5051 GAYHURST AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-1813
Mailing Address - Country:US
Mailing Address - Phone:253-228-0717
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF CALIFORNIA SAN DIEGO 9500 GILMAN DR
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0001
Practice Address - Country:US
Practice Address - Phone:858-534-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program