Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | A138961 | CA |
NPI | 1194139253 |
---|---|
Provider Name | Dr. David Shin |
First Address | Long Beach, CA 90806-1625 |
Second Address | San Jose, CA 95128-1633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2014 |
Last Update Date | 29/11/2021 |