Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | A106933 | CA |
NPI | 1083754261 |
---|---|
Provider Name | Peter E Shin |
First Address | Glendale, CA 91205-1047 |
Second Address | Glendale, CA 91206-4007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 20/06/2012 |