=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982688511
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MYUNG HYO SHIN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2005
-----------------------------------------------------
Last Update Date | 07/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 E ALLEGHENY AVE SUITE 180
-----------------------------------------------------
City | PHILA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19134-4427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-969-3700
-----------------------------------------------------
Fax | 215-939-3703
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 820933
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19182-0933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-926-9010
-----------------------------------------------------
Fax | 215-226-8285
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | MD032923L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------