Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A16924 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | 20A16924 | CA |
N | 208D00000X | General Practice Physician | 16924 | CA |
NPI | 1063837631 |
---|---|
Provider Name | Victoria Belle Yea Ri Shin |
First Address | Riverside, CA 92507-4233 |
Second Address | Moreno Valley, CA 92555-3927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2014 |
Last Update Date | 15/07/2021 |