Jiwon Shin, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

25607 Issued in CA

Practice address

1902 Royalty Dr # 170
Pomona, CA 91767-3030

Phone

(909) 620-9700

NPI assigned

Oct 12, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Able Physical Therapy Corp

  • Physical Therapist
  • Pomona, CA
  • NPI 1902079452
  NPD

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

{
    "created_epoch": "1633996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1205598794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1902 ROYALTY DR # 170",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673030",
            "telephone_number": "909-620-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1902 ROYALTY DR # 170",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673030",
            "telephone_number": "909-620-9700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 E Lincoln Ave Ste 111",
            "address_purpose": "LOCATION",
            "city": "Anaheim",
            "state": "CA",
            "postal_code": "928053203",
            "country_code": "US",
            "telephone_number": "714-947-1213",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIN",
        "first_name": "JIWON",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-12",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "25607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Shigenaga
• Tyson Shih, MD
• Iris Shim
• Harry Shin
• Jason Haeshik Shin, M. D.
• Joseph Joonyoung Shin
• Niloofar Shirazi
• Mary Shirley
• Danika Shively
• Sally Shively

• Occupational Therapist in Pomona, CA
• Providers in Pomona, CA by specialty
• Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; 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.