Individual provider Active NPI

Cathy Eun-Young Shin, MD

  • Pediatric Surgery Physician
  • Los Angeles, CA
National Provider Identifier
1265528194
Registry record updated Aug 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
A75668 Issued in CA
Practice address
4650 W Sunset Blvd
Ms# 100
Los Angeles, CA 90027-6062
Phone
(323) 361-2322
Fax
(323) 361-4775
NPI assigned
Oct 5, 2006
Last updated
Aug 8, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery Physician 2086S0120X A75668 CA Primary

Addresses

Primary practice location

4650 W Sunset Blvd
Ms# 100
Los Angeles, CA 90027-6062

Mailing address

6430 W Sunset Blvd
Suite 600
Los Angeles, CA 90028-7901
Phone (323) 361-2337

Other identifiers 1

IdentifierTypeStateIssuer
00A756680MedicaidCA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041102000809 CA Practitioner - General SurgeryPractitioner - Pediatric Medicine 3476515321 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
George Washington University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Childrens Hospital Los Angeles Medical Group IncGroup PAC ID 0143126920, 288 clinicians

Practice addresses (Care Compare)

4650 W Sunset Blvd
Los Angeles, CA 90027-6062
Phone (323) 361-8408

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
75668CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Hospital Los Angeles Medical Group, Inc. CurrentSince Mar 10, 2013 Accepting new patients
Childrens Hospital of Los Angeles Past Accepting new patients
Children's Hospital Los Angeles Past Accepting new patients

Locations

3701 Wilshire Blvd
Ste 600
Los Angeles, CA 90010
Phone (323) 361-3550

4650 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 361-2122

4650 W Sunset Blvd
#100
Los Angeles, CA 90027
Phone (323) 361-2322

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312761600000",
    "number": "1265528194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6430 W SUNSET BLVD",
            "address_2": "SUITE 600",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900287901",
            "telephone_number": "323-361-2337",
            "fax_number": "323-361-8491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 W SUNSET BLVD",
            "address_2": "MS# 100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276062",
            "telephone_number": "323-361-2322",
            "fax_number": "323-361-4775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIN",
        "first_name": "CATHY",
        "middle_name": "EUN-YOUNG",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2011-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "CA",
            "license": "A75668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A756680",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.