Organization
TAE M SHIN, M.D. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ROSE MARIE RIVERA (DIRECTOR OF BILLING OPERATIONS)
(805) 577-8730
Entity
Organization
Contact information
Practice address
4220 W 3RD ST, SUITE #208, LOS ANGELES, CA 90020-3450
(213) 386-3554
(805) 991-4065
Mailing address
PO BOX 65, SIMI VALLEY, CA 93062-0065
(805) 577-8730
(805) 991-4065
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
G85170
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G851700
—
CA
Enumeration date
03/07/2007
Last updated
08/22/2020
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