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NPI Code Detail

MEDICARE: DANIEL SHIN DO

MEDICARE: DANIEL SHIN DO
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
1207R00000XInternal Medicine Physician4571360ID
2207R00000XInternal Medicine PhysicianDO70006050WA

General Provider Information

NPI Number : 1568112597
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL SHIN DO
Provider Business Mailing Address
First Line : 115 W MAIN ST STE 201
Second Line :
City : BOISE
State : ID
Zip : 83702-7303
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1055 N CURTIS RD
Second Line :
City : BOISE
State : ID
Zip : 83706-1309
Country : US
Telephone Number : 208-505-4437
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2022
Last Update Date : 03/25/2026

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Directions to “ DANIEL SHIN DO” Practice Location

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