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General NPI Number Information
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NPI Number | 1245672799
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Entity Type | Individual
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Provider Name | EUN SUP SHIN D.M.D
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Gender | Male
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 1416 NW 46TH ST STE 106
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City | SEATTLE
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State | WA
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Zip | 98107-4622
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Country | US
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Telephone | 206-783-0330
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 3RD AVE APT 112
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City | SEATTLE
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State | WA
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Zip | 98121-1490
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Country | US
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Telephone | 805-231-6067
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1856359
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60476969
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License Number State | WA
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