Healthcare Provider Details

I. General information

NPI: 1619886686
Provider Name (Legal Business Name): YOO JIN SHIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18904 64TH AVE APT 10B
FRESH MEADOWS NY
11365-3847
US

IV. Provider business mailing address

18904 64TH AVE APT 10B
FRESH MEADOWS NY
11365-3847
US

V. Phone/Fax

Practice location:
  • Phone: 718-687-2357
  • Fax:
Mailing address:
  • Phone: 718-687-2357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number026685-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007948-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: