MEDICARE: GRACE S SHIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	7373	NV
2	207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician Physician	7373	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063501500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE S SHIN M.D.

Provider Business Mailing Address
First Line	:	6028 S FORT APACHE RD STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5612
Country	:	US
Telephone Number	:	702-896-2020
Fax Number	:	702-896-2025

Provider Business Practice Location Address
First Line	:	6028 S FORT APACHE RD STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5612
Country	:	US
Telephone Number	:	702-896-2020
Fax Number	:	702-896-2025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/21/2022

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Directions to “ GRACE S SHIN M.D.” Practice Location

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