Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E4623 | CA |
NPI | 1053422253 |
---|---|
Provider Name | Dr. Christopher Shin |
First Address | Murrieta, CA 92563-9110 |
Second Address | Murrieta, CA 92563-9101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 23/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V06022 | (02) | CA |