Healthcare Provider Details

I. General information

NPI: 1104837079
Provider Name (Legal Business Name): RICHARD D. SHIN, M.D., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W LAKE ST
MELROSE PARK IL
60160-4039
US

IV. Provider business mailing address

1730 PARK ST SUITE 101
NAPERVILLE IL
60563-2688
US

V. Phone/Fax

Practice location:
  • Phone: 708-938-7580
  • Fax: 708-938-7381
Mailing address:
  • Phone: 630-718-0200
  • Fax: 630-718-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD D SHIN
Title or Position: PHYSICIAN / OWNER
Credential: M.D.
Phone: 630-718-0200