Healthcare Provider Details

I. General information

NPI: 1346647344
Provider Name (Legal Business Name): WILLIAM K SHIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 CASTLEBERRY RD STE 300
CUMMING GA
30040-8054
US

IV. Provider business mailing address

5520 CASTLEBERRY RD STE 300
CUMMING GA
30040-8054
US

V. Phone/Fax

Practice location:
  • Phone: 470-239-4289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN015403
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: