Active NPI
Berthold Shin, DO
- Psychiatry Physician
- Los Angeles, CA
National Provider Identifier
1255745477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 291509
- Practice address
- 801 S Grand Ave
Los Angeles, CA 90017-4613 - Phone
- (714) 336-7446
- NPI assigned
- Jun 16, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 259895 | MA | |
| Psychiatry Physician | 2084P0800X | 291509 | NY | Primary |
Addresses
Primary practice location
801 S Grand Ave
Los Angeles, CA 90017-4613
Mailing address
801 S Grand Ave
Los Angeles, CA 90017-4674
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 291509 | NY | MD | Licensed Practical Nurse |
| 259895 | MA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609113600000",
"number": "1255745477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 S GRAND AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900174674"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 S GRAND AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900174613",
"telephone_number": "714-336-7446"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIN",
"first_name": "BERTHOLD",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-06-16",
"last_updated": "2020-12-28",
"certification_date": "2020-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MA",
"license": "259895",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NY",
"license": "291509",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.