Provider Demographics
NPI:1831620996
Name:SHIN IMAGING RADIOLOGY ASSOCIATES
Entity type:Organization
Organization Name:SHIN IMAGING RADIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:DORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-578-8882
Mailing Address - Street 1:1955 SUNNYCREST DR
Mailing Address - Street 2:STE 110
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3654
Mailing Address - Country:US
Mailing Address - Phone:714-578-8882
Mailing Address - Fax:
Practice Address - Street 1:1955 SUNNYCREST DR
Practice Address - Street 2:STE 110
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3654
Practice Address - Country:US
Practice Address - Phone:714-578-8882
Practice Address - Fax:714-578-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology