Healthcare Provider Details

I. General information

NPI: 1104256015
Provider Name (Legal Business Name): YOUNG SHIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5433 W FOND DU LAC AVE
MILWAUKEE WI
53216-1382
US

IV. Provider business mailing address

8915 W CONNELL AVE
MILWAUKEE WI
53226-3067
US

V. Phone/Fax

Practice location:
  • Phone: 414-277-8900
  • Fax:
Mailing address:
  • Phone: 414-266-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6002006-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: