Provider Demographics
NPI:1720245186
Name:SHIN, EDWARD C (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:C
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1838 EL CAMINO REAL STE 100
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3105
Mailing Address - Country:US
Mailing Address - Phone:415-346-1114
Mailing Address - Fax:415-634-0206
Practice Address - Street 1:1838 EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3105
Practice Address - Country:US
Practice Address - Phone:415-346-1114
Practice Address - Fax:415-634-0206
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA108147207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine