SE Jung Shin MD Professional Corporation

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

36696 Issued in OR

Legal business name

SE JUNG SHIN MD PROFESSIONAL CORPORATION

Doing business as

Cornell Urgent Care

Practice address

13305 NW Cornell Road, Suite C
Portland, OR 97229

Phone

(503) 646-8500

Fax

(503) 646-8200

NPI assigned

Jun 19, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. SE Jung Shin, M.D. PC

Title

President

Phone

(503) 646-8500

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Cornell Urgent Care Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429142400000",
    "number": "1184829244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13305 NW CORNELL RD",
            "address_2": "SUITE C",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972295987",
            "telephone_number": "503-646-8500",
            "fax_number": "503-646-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13305 NW CORNELL ROAD, SUITE C",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97229",
            "telephone_number": "503-646-8500",
            "fax_number": "503-646-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SE JUNG SHIN MD PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-19",
        "last_updated": "2015-04-16",
        "status": "A",
        "authorized_official_last_name": "SHIN",
        "authorized_official_first_name": "SE JUNG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-646-8500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D. PC"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "36696",
            "primary": true
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "OR",
            "license": "36696",
            "primary": false
        },
        {
            "code": "207PP0204X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "OR",
            "license": "36696",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "1184829244",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cornell Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amanda Christine Scully, MD, FAAP
• SD Wellness LLC
• Athena L Sdrales, DO
• Andrei D Sdrulla, MD, PHD
• Rachel Layne Sdrulla, CRNP
• Kim Seales, CPHT
• Alexis Seaman
• Jenna Seaman
• Karen D. Seamans, RCI
• Sean R. White, DC LLC

• Emergency Medicine Physician in Portland, OR
• Providers in Portland, OR by specialty
• Emergency Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.