Provider Demographics
NPI:1073665436
Name:SHIN, EUN I (MD)
Entity type:Individual
Prefix:
First Name:EUN
Middle Name:I
Last Name:SHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 S. WESTMORELAND AVENUE
Mailing Address - Street 2:STE 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005
Mailing Address - Country:US
Mailing Address - Phone:800-821-5675
Mailing Address - Fax:213-289-1166
Practice Address - Street 1:3663 W 6TH ST STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3047
Practice Address - Country:US
Practice Address - Phone:213-388-5144
Practice Address - Fax:213-388-5154
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31059208D00000X, 207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA31059OtherMEDICAL LICENSE