Healthcare Provider Details

I. General information

NPI: 1952089591
Provider Name (Legal Business Name): SANGHO SHIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6832 KATELLA AVE
CYPRESS CA
90630-5108
US

IV. Provider business mailing address

6832 KATELLA AVE
CYPRESS CA
90630-5108
US

V. Phone/Fax

Practice location:
  • Phone: 657-279-8163
  • Fax:
Mailing address:
  • Phone: 657-279-8163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS113632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: