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General NPI Number Information
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NPI Number | 1114186798
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Entity Type | Organization
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Legal Business Name | CHARLES C SHIN MD INC
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 04/09/2009
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Provider Practice Location Address
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Address Line | 7225 OLD OAK BLVD SUITE B312
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City | MIDDLEBURG HTS
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State | OH
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Zip | 44130-3377
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Country | US
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Telephone | 440-816-2730
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Fax | 440-816-5352
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Provider Business Mailing Address
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Address Line | 7225 OLD OAK BLVD SUITE B312
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City | MIDDLEBURG HTS
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State | OH
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Zip | 44130-3377
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Country | US
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Telephone | 440-816-2730
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Fax | 440-816-5352
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES C SHIN
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Credential | MD
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Telephone | 440-816-2730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 35100181
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License Number State | OH
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