Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 130231 | CA |
Y | 207RP1001X | Pulmonary Disease | 130231 | CA |
NPI | 1023317286 |
---|---|
Provider Name | Stephanie Shin |
First Address | San Diego, CA 92130 |
Second Address | Encinitas, CA 92024-5138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2011 |
Last Update Date | 29/04/2020 |