1760516736 NPI number — YONGJEAN SHIN D.D.S.

Table of content: YONGJEAN SHIN D.D.S. (NPI 1760516736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760516736 NPI number — YONGJEAN SHIN D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIN
Provider First Name:
YONGJEAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760516736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1739 S EUCLID AVE
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
ONTARIO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91762-5831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-983-9325
Provider Business Mailing Address Fax Number:
909-467-9956

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1739 S EUCLID AVE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
ONTARIO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91762-5831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-983-9325
Provider Business Practice Location Address Fax Number:
909-467-9956
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  49670 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: D49670 . This is a "DENTICAL RENDERING PROVID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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