Healthcare Provider Details

I. General information

NPI: 1992383905
Provider Name (Legal Business Name): DANIEL HEAN SHIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 W BRAMBLETON AVE
NORFOLK VA
23510-1005
US

IV. Provider business mailing address

855 W BRAMBLETON AVE
NORFOLK VA
23510-1005
US

V. Phone/Fax

Practice location:
  • Phone: 757-446-5910
  • Fax: 757-625-0466
Mailing address:
  • Phone: 757-446-5910
  • Fax: 757-625-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number0101289546
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: