Provider Demographics
NPI:1366922346
Name:SHIN SHIN TANG PHD. INC
Entity type:Organization
Organization Name:SHIN SHIN TANG PHD. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIN SHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-953-4969
Mailing Address - Street 1:1339 OAK ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3582
Mailing Address - Country:US
Mailing Address - Phone:541-953-4969
Mailing Address - Fax:
Practice Address - Street 1:1339 OAK ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3582
Practice Address - Country:US
Practice Address - Phone:541-953-4969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-18
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2196103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty