Provider Demographics
NPI:1316926678
Name:SHIN, JASON HAESHIK (M D)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:HAESHIK
Last Name:SHIN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 W BONITA AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1863
Mailing Address - Country:US
Mailing Address - Phone:909-593-2031
Mailing Address - Fax:909-593-2032
Practice Address - Street 1:250 W BONITA AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1863
Practice Address - Country:US
Practice Address - Phone:909-593-2031
Practice Address - Fax:909-593-2032
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA46382207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F49457Medicare UPIN