Healthcare Provider Details

I. General information

NPI: 1558419333
Provider Name (Legal Business Name): HYUN JIN SHIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HYUN JIN KIM MD

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7405 SHALLOWFORD RD
CHATTANOOGA TN
37421-2661
US

IV. Provider business mailing address

7405 SHALLOWFORD RD STE 270
CHATTANOOGA TN
37421-2662
US

V. Phone/Fax

Practice location:
  • Phone: 423-605-9545
  • Fax:
Mailing address:
  • Phone: 423-602-9545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01072369A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA74088
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number64599
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: