Basic Information
| Provider Information | |||||||||
| NPI: | 1538319959 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MIYATA | ||||||||
| FirstName: | SHIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3701 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900102814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233613550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4650 SUNSET BLVD | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900276062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233613550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2008 | ||||||||
| LastUpdateDate: | 03/08/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 4301091842 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0120X | A123051 | CA | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
No ID Information.