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NPI Code Detail

MEDICARE: GRACE S SHIN MD LTD

MEDICARE: GRACE S SHIN MD LTD
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
1207W00000XOphthalmology Physician7373NV

General Provider Information

NPI Number : 1164668661
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRACE S SHIN MD LTD
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
Country : US
Telephone Number : 702-896-2020
Fax Number : 702-896-2025
Authorized Official
Title or Position : MANAGER
Name : JENNIFER L BRATTEN
Credential :
Telephone Number : 702-896-2020
Provider Enumeration Date : 01/05/2009
Last Update Date : 08/21/2025

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