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General NPI Number Information
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NPI Number | 1477577682
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Entity Type | Individual
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Provider Name | JOHN JUNGHOON SHIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 385 TREMONT AVE VETERANS AFFAIRS MEDICAL CENTER, MEDICAL (111)
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City | EAST ORANGE
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State | NJ
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Zip | 07018-1023
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Country | US
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Telephone | 973-676-1000
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Fax | 973-395-7091
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Provider Business Mailing Address
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Address Line | 330 ABBEY CT
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-1801
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Country | US
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Telephone | 201-676-2245
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 25MA07717400
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License Number State | NJ
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