Healthcare Provider Details

I. General information

NPI: 1841228608
Provider Name (Legal Business Name): EON K SHIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 CHESTNUT ST SUITE G114
PHILADELPHIA PA
19107-5127
US

IV. Provider business mailing address

834 CHESTNUT ST SUITE G114
PHILADELPHIA PA
19107-5127
US

V. Phone/Fax

Practice location:
  • Phone: 215-521-3000
  • Fax: 215-521-3002
Mailing address:
  • Phone: 215-521-3000
  • Fax: 215-521-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number227333
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD431878
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number25MA08306100
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD431878
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA08306100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: