Individual
MR. BRIAN JISU SHIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
8293 PERLA DR, RIVERSIDE, CA 92504-2419
(951) 214-0212
Mailing address
8293 PERLA DR, RIVERSIDE, CA 92504-2419
(951) 214-0212
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
58316
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/14/2020
Last updated
01/21/2026
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