Provider Demographics
NPI:1841850195
Name:SHIN, JOSEPHINE OK KYUNG (PT)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:OK KYUNG
Last Name:SHIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 ALTA LOMA DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-2240
Mailing Address - Country:US
Mailing Address - Phone:415-314-0320
Mailing Address - Fax:415-931-6724
Practice Address - Street 1:1426 FILLMORE ST STE 209
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-4164
Practice Address - Country:US
Practice Address - Phone:415-931-7878
Practice Address - Fax:415-931-6724
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty