Individual ProviderDesiree ShinNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address200 Medical Plaza Driveway, Los Angeles, CA 90095-0001(310) 825-8061(310) 267-8953PECOS EnrollmentBased on the most recent information from CMS, provider Desiree Shin is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 11 days ago.Profile DetailsProvider ID1457038945Provider TypeIndividualFull NameShin, DesireeCredentialMSN, AGACNP-BCGenderFemaleSole ProprietorNoEnumeration Date6/28/2023Last Updated6/28/2023Contact InformationPractice LocationPractice Address200 Medical Plaza Driveway, Los Angeles, CA 90095-0001Phone(310) 825-8061FaxUnlisted FaxMailing LocationMailing Address1145 Gayley Ave, Los Angeles, CA 90024-3423Phone(310) 267-8953FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LA2100XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense95016669California