Garden Grove Podiatry

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

GARDEN GROVE PODIATRY

Practice address

12665 Garden Grove Blvd Ste 203
Garden Grove, CA 92843-1916

Phone

(714) 620-4699

Fax

(888) 866-7055

NPI assigned

Dec 23, 2020

Last updated

Sep 21, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Marie Shin, DPMNPI 1275824971

Title

President

Phone

(714) 620-4699

Specialties & licenses 1

Addresses

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, and the practitioner matching its NPPES authorized official.

• Marie Wonkyong Shin, DPM

  • Primary Podiatric Medicine Podiatrist
  • Garden Grove, CA
  • NPI 1275824971

  Foot & Ankle Surgery

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1608681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632182400000",
    "number": "1447847546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12665 GARDEN GROVE BLVD STE 203",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431916",
            "telephone_number": "714-620-4699",
            "fax_number": "888-866-7055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12665 GARDEN GROVE BLVD STE 203",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431916",
            "telephone_number": "714-620-4699",
            "fax_number": "888-866-7055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11637 The Plz",
            "address_purpose": "LOCATION",
            "city": "Norwalk",
            "state": "CA",
            "postal_code": "906503930",
            "country_code": "US",
            "telephone_number": "562-318-0810",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1706 W Orangethorpe Ave Ste D",
            "address_purpose": "LOCATION",
            "city": "Fullerton",
            "state": "CA",
            "postal_code": "928334556",
            "country_code": "US",
            "telephone_number": "714-620-4699",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GARDEN GROVE PODIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-23",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A",
        "authorized_official_last_name": "SHIN",
        "authorized_official_first_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-620-4699",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Garden Grove MRI Center
• Garden Grove Open MRI Center,Inc (Healthplus Imaging)
• Garden Grove Operations, LLC (Savant of Garden Grove)
• Garden Grove Outpatient Surgery Center
• Garden Grove Physical Therapy Inc
• Garden Grove Post Acute LLC (The Grove Post Acute)
• Garden Grove Primary Care Medicine, Inc.
• Garden Grove Surgical Center Inc
• Garden Grove Unified School District
• Garden Grove Unified School District

• Foot & Ankle Surgery Podiatrist in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Foot & Ankle Surgery Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; 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.