NPIMap

Organization Active NPI

Shin Imaging LLC

  • Radiology Clinic/Center
  • Fullerton, CA
National Provider Identifier
1235689175
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
SHIN IMAGING LLC
Practice address
1955 Sunnycrest Dr Ste 110
Fullerton, CA 92835-3653
Phone
(310) 995-6689
NPI assigned
Oct 4, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Charles J Maloney
Title
President
Phone
(310) 995-6689

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

1955 Sunnycrest Dr Ste 110
Fullerton, CA 92835-3653

Mailing address

1955 Sunny Crest Dr Ste 110
Fullerton, CA 92835-3653
Phone (714) 578-8882

Other practice location 1

5832 Beach Blvd # 104
Buena Park, CA 90621-2022
Phone (714) 578-8882

Other names 1

  • Shin Imaging Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170712000179 CA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1850677402 Practice locations: Fullerton, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Shin Imaging2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

5832 Beach Blvd
Unit 104
Buena Park, CA 90621

Practitioners & affiliated clinicians

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1475539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1235689175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1955 SUNNY CREST DR STE 110",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353653",
            "telephone_number": "714-578-8882",
            "fax_number": "714-578-8886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1955 SUNNYCREST DR STE 110",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353653",
            "telephone_number": "310-995-6689"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5832 Beach Blvd # 104",
            "address_purpose": "LOCATION",
            "city": "Buena Park",
            "state": "CA",
            "postal_code": "906212022",
            "country_code": "US",
            "telephone_number": "714-578-8882",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SHIN IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-04",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "MALONEY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-995-6689"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shin Imaging Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fullerton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.