MEDICARE: DAVID DONGRYUN SHIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	K6323	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8199K1	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083614135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID DONGRYUN SHIN MD

Provider Business Mailing Address
First Line	:	6550 FANNIN ST
Second Line	:	STE 2407
City	:	HOUSTON
State	:	TX
Zip	:	77030-2748
Country	:	US
Telephone Number	:	713-790-5227
Fax Number	:	713-790-5505

Provider Business Practice Location Address
First Line	:	6550 FANNIN ST STE 2407
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2748
Country	:	US
Telephone Number	:	713-790-0000
Fax Number	:	713-790-1212

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	12/08/2020

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Directions to “ DAVID DONGRYUN SHIN MD” Practice Location

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