Active NPI
Young Shin, N.P.
- Adult Health Nurse Practitioner
- El Segundo, CA
National Provider Identifier
1114460565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 8481
- Practice address
- 2101 Rosecrans Ave # 3230
El Segundo, CA 90245-4749 - Phone
- (323) 628-8671
- NPI assigned
- Dec 1, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 8481 | CA | Primary |
Addresses
Primary practice location
2101 Rosecrans Ave # 3230
El Segundo, CA 90245-4749
Mailing address
1700 Westwood Blvd
Los Angeles, CA 90024-5608
Phone (818) 952-5097
Other practice location 1
4956 Revlon Dr
LA Canada, CA 91011-3630
Phone (818) 952-5097
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8481 | CA | MD | Speech-Language Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Concertocare Medical Group of California, P.C. | Past | Accepting new patients |
Interoperability endpoints
- yshin@landmarkhealth-direct.org
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Internal Medicine Physician
- Huntington Beach, CA
- NPI 1922777259
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1480550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571875200000",
"number": "1114460565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1700 WESTWOOD BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900245608",
"telephone_number": "818-952-5097",
"fax_number": "888-580-6761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 ROSECRANS AVE # 3230",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902454749",
"telephone_number": "323-628-8671"
}
],
"practiceLocations": [
{
"address_1": "4956 Revlon Dr",
"address_purpose": "LOCATION",
"city": "LA Canada",
"state": "CA",
"postal_code": "910113630",
"country_code": "US",
"telephone_number": "818-952-5097",
"fax_number": "888-580-6761",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHIN",
"first_name": "YOUNG",
"credential": "N.P.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-12-01",
"last_updated": "2019-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "CA",
"license": "8481",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Segundo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.