Organization
SE JUNG SHIN MD PROFESSIONAL CORPORATION
Active
Other names
Cornell Urgent Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SE JUNG SHIN M.D. PC (PRESIDENT)
(503) 646-8500
Entity
Organization
Contact information
Practice address
13305 NW CORNELL ROAD, SUITE C, PORTLAND, OR 97229
(503) 646-8500
(503) 646-8200
Mailing address
13305 NW CORNELL RD, SUITE C, PORTLAND, OR 97229-5987
(503) 646-8500
(503) 646-8200
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
36696
OR
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
36696
OR
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
36696
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1184829244
NPI NUMBER
—
Enumeration date
06/19/2007
Last updated
04/16/2015
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