Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 25MD00308000 | NJ |
N | 213ES0103X | Foot & Ankle Surgery | PO3564 | FL |
NPI | 1275824971 |
---|---|
Provider Name | Marie Wonkyong Shin |
First Address | Pembroke Pines, FL 33024-3623 |
Second Address | Pembroke Pines, FL 33024-3623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2011 |
Last Update Date | 14/12/2016 |