Provider Demographics
NPI:1487358230
Name:BIN, SITHY
Entity type:Individual
Prefix:
First Name:SITHY
Middle Name:
Last Name:BIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8145 CANBY AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3143
Mailing Address - Country:US
Mailing Address - Phone:707-239-9266
Mailing Address - Fax:
Practice Address - Street 1:8145 CANBY AVE UNIT 3
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3143
Practice Address - Country:US
Practice Address - Phone:707-239-9266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-DJKRWT175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty