Provider Demographics
NPI:1881043362
Name:SHIN, MIN JI
Entity type:Individual
Prefix:
First Name:MIN
Middle Name:JI
Last Name:SHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 W 8TH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-5030
Mailing Address - Country:US
Mailing Address - Phone:213-674-7120
Mailing Address - Fax:213-674-7270
Practice Address - Street 1:3525 W 8TH ST STE 109
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-5030
Practice Address - Country:US
Practice Address - Phone:213-674-7120
Practice Address - Fax:213-674-7270
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist