Active NPI
Edward Jongeun Shin
- Marriage & Family Therapist
- Riverside, CA
National Provider Identifier
1356857387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 40646
- Practice address
- 2085 Rustin Ave
Suite 2002
Riverside, CA 92507 - Phone
- (951) 955-7320
- Fax
- (951) 955-7203
- NPI assigned
- Dec 28, 2017
- Last updated
- Dec 28, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 40646 | CA | Primary |
Addresses
Primary practice location
2085 Rustin Ave
Suite 2002
Riverside, CA 92507
Mailing address
136 N Lohrum LN
Anaheim, CA 92807-3114
Phone (951) 955-7320
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40646 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1514419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1514419200000",
"number": "1356857387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "136 N LOHRUM LN",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928073114",
"telephone_number": "951-955-7320",
"fax_number": "951-955-7203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2085 RUSTIN AVE",
"address_2": "SUITE 2002",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "92507",
"telephone_number": "951-955-7320",
"fax_number": "951-955-7203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIN",
"first_name": "EDWARD",
"middle_name": "JONGEUN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-12-28",
"last_updated": "2017-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "40646",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.