Jieun Shin

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

NP95008532 Issued in CA

Practice address

9896 Garden Grove Blvd
Garden Grove, CA 92844-1643

Phone

(714) 636-3032

Fax

(714) 636-3116

NPI assigned

Mar 7, 2018

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Garden Grove Medical Group Inc

  • General Practice Physician
  • Garden Grove, CA
  • NPI 1972781458
  Medicare reassignment NPD
• Kyoung Tae Ha, D.D.S., Inc.

  • General Practice Dentistry
  • Anaheim, CA
  • NPI 1972360303
  NPD (past)

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

{
    "created_epoch": "1520380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653436800000",
    "number": "1275035917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9896 GARDEN GROVE BLVD",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928441643",
            "telephone_number": "714-636-3032",
            "fax_number": "714-636-3032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9896 GARDEN GROVE BLVD",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928441643",
            "telephone_number": "714-636-3032",
            "fax_number": "714-636-3116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIN",
        "first_name": "JIEUN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-07",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "NP95008532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Shim
• Eriko Shimojo
• Christina Shin, OTD, OTR/L, CLT-LANA
• David Shin
• Dong Joo Shin
• John Sanghyun Shin, DISPENSER
• Kevin Y Shin, DC
• Marie Wonkyong Shin, DPM
• Sang Yun Shin, L.AC.
• Young Kyu Shin, DC

• Primary Care Nurse Practitioner in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Primary Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.