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General NPI Number Information
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NPI Number | 1154687218
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Entity Type | Individual
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Provider Name | THOMAS SHIN DMD
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Gender | Male
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Dates
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Enumeration Date | 04/03/2012
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 1325 18TH ST NW STE 203
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City | WASHINGTON
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State | DC
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Zip | 20036-6501
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Country | US
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Telephone | 202-716-7626
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Fax |
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Provider Business Mailing Address
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Address Line | 1325 18TH ST NW STE 203
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City | WASHINGTON
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State | DC
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Zip | 20036-6501
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Country | US
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Telephone | 202-716-7626
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DI02497100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401413918
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License Number State | VA
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