Healthcare Provider Details

I. General information

NPI: 1821938242
Provider Name (Legal Business Name): MINGYU SHIN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MACDADE BLVD STE G
DARBY PA
19023-1814
US

IV. Provider business mailing address

450 N 18TH ST APT 1134
PHILADELPHIA PA
19130-4199
US

V. Phone/Fax

Practice location:
  • Phone: 610-583-2020
  • Fax:
Mailing address:
  • Phone: 573-292-9662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS045774
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: