Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 22219 | OK |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A97516 | CA |
N | 207YP0228X | Pediatric Otolaryngology | 22219 | OK |
N | 207YS0123X | Facial Plastic Surgeon | 22219 | OK |
NPI | 1992791495 |
---|---|
Provider Name | Mike S. Shin |
First Address | Hanford, CA 93230-4926 |
Second Address | Hanford, CA 93230-4926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 08/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OTH000 | (02) | IL |