Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 102968 | CA |
Y | 213EG0000X | General Practice | 102968 | CA |
NPI | 1003396128 |
---|---|
Provider Name | Stephanie Jer Shyn |
First Address | Millbrae, CA 94030-1513 |
Second Address | Millbrae, CA 94030-1513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2018 |
Last Update Date | 17/08/2018 |