Healthcare Provider Details

I. General information

NPI: 1487580684
Provider Name (Legal Business Name): MYUNG SHIK SHIN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E BUENA VISTA ST
BARSTOW CA
92311-2803
US

IV. Provider business mailing address

26149 PARK AVE UNIT 1
LOMA LINDA CA
92354-6128
US

V. Phone/Fax

Practice location:
  • Phone: 909-328-9713
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MYUNG SHIK SHIN
Title or Position: CEO
Credential:
Phone: 909-328-9713