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General NPI Number Information
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NPI Number | 1972599249
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Entity Type | Organization
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Legal Business Name | WONSOCK SHIN MD LLC
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 410 PINE ST SE SUITE 200
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City | VIENNA
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State | VA
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Zip | 22180-4861
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Country | US
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Telephone | 703-865-8615
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Fax | 301-777-7455
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Provider Business Mailing Address
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Address Line | 410 PINE ST SE SUITE 200
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City | VIENNA
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State | VA
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Zip | 22180-4861
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Country | US
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Telephone | 703-865-8615
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Fax | 301-777-7455
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. WONSOCK SHIN
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Credential | M.D.
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Telephone | 703-865-8615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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