Healthcare Provider Details

I. General information

NPI: 1346775392
Provider Name (Legal Business Name): YOON SHIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 13TH ST
BROOKLYN NY
11215-4802
US

IV. Provider business mailing address

220 13TH ST
BROOKLYN NY
11215-4802
US

V. Phone/Fax

Practice location:
  • Phone: 718-832-5980
  • Fax:
Mailing address:
  • Phone: 718-832-5980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60975728
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number314375
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: