Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 0101030663 | VA |
N | 2081P2900X | Pain Medicine | 0101030663 | VA |
N | 2081S0010X | Sports Medicine | 0101030663 | VA |
N | 213ES0000X | Sports Medicine | 0101030663 | VA |
NPI | 1073521340 |
---|---|
Provider Name | Dr. Wan Shin |
First Address | Fredericksburg, VA 22402-1460 |
Second Address | Fredericksburg, VA 22401-3387 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 21/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006841643 | (05) | VA |
1073521340 | (05) | VA |
C62452 | (02) | |
VV3775A | (02) | VA |