1396886727 NPI number — DR. RICHARD C SHIN DDS, MS

Table of content: DR. RICHARD C SHIN DDS, MS (NPI 1396886727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396886727 NPI number — DR. RICHARD C SHIN DDS, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIN
Provider First Name:
RICHARD
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS, MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHIN
Provider Other First Name:
CHONG
Provider Other Middle Name:
YUN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS, MS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396886727
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4701 RANDOLPH RD STE 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-770-7770
Provider Business Mailing Address Fax Number:
301-770-7776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4701 RANDOLPH RD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20852-2257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-770-7770
Provider Business Practice Location Address Fax Number:
301-770-7776
Provider Enumeration Date:
02/09/2007

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: 1223X0400X , with the licence number:  13685 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 085244900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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