Provider Demographics
NPI:1386304392
Name:SHIN, HANNAH HAESOO (NP)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:HAESOO
Last Name:SHIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:HAESOO
Other - Last Name:JUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 UCLA MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-4011
Practice Address - Country:US
Practice Address - Phone:310-206-7663
Practice Address - Fax:310-794-9718
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017907363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care