Kwangsun C Shin

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY46563 Issued in CA

Legal business name

KWANGSUN C SHIN

Practice address

15074 Imperial Hwy
La Mirada, CA 90638-1301

Phone

(562) 902-5580

Fax

(562) 902-5589

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Kwangsun ShinNPI 1093274128

Title

Owner & Pic

Phone

(562) 902-5580

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• IMPERIAL PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

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

• Kwangsun Chun Shin

  • Community/Retail Pharmacy
  • La Mirada, CA
  • NPI 1093274128
  NPD Authorized official

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480550400000",
    "number": "1316044159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15074 IMPERIAL HWY",
            "city": "LA MIRADA",
            "state": "CA",
            "postal_code": "906381301",
            "telephone_number": "562-902-5580",
            "fax_number": "562-902-5589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15074 IMPERIAL HWY",
            "city": "LA MIRADA",
            "state": "CA",
            "postal_code": "906381301",
            "telephone_number": "562-902-5580",
            "fax_number": "562-902-5589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KWANGSUN C SHIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2016-12-01",
        "status": "A",
        "authorized_official_last_name": "SHIN",
        "authorized_official_first_name": "KWANGSUN",
        "authorized_official_title_or_position": "OWNER & PIC",
        "authorized_official_telephone_number": "562-902-5580"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY46563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2112601",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA465630",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMPERIAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Divakar Krishnareddy, M.D
• Bon Seong Ku, L.AC
• Wayne Kuang, DO
• Konrad Kirk Kuenstler, PT
• Jana Kukla
• Young Je Kwon
• La Mirada Family Dental
• La Mirada Healtchare LLC
• La Mirada Healthcare, LLC
• La Mirada Optometry

• Community/Retail Pharmacy in La Mirada, CA
• Providers in La Mirada, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2016; 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.