Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D9031 | OR |
NPI | 1194914515 |
---|---|
Provider Name | Rebecca Hea-Sun Shin |
First Address | Cornelius, OR 97113-0568 |
Second Address | Hillsboro, OR 97123-4245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2007 |
Last Update Date | 22/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
023197 | (05) | OR |