Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 01030149 | IN |
NPI | 1003800087 |
---|---|
Provider Name | Robert B Shin |
First Address | Kokomo, IN 46902-3828 |
Second Address | Kokomo, IN 46902-3828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000086068 | ANTHEM (01) | IN |
351639719001 | TRICARE (01) | IN |
C24389 | (02) |