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
1	207W00000X	Ophthalmology Physician	7373	NV

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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