MEDICARE: DR. CHUNG K 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	174400000X	Specialist	037720	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0V7050	OTHER	CT	HEALTHNET
2	01377200CT03	OTHER	CT	BLUE CROSS
3	P2061278	OTHER	CT	OXFORD
4	037720	OTHER	CT	CONNECTICARE
5	178311	OTHER	CT	WELLCARE
6	2322912	OTHER	CT	AETNA
7	3324246-004	OTHER	CT	CIGNA

General Provider Information

NPI Number	:	1386791143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHUNG K SHIN M.D.

Provider Business Mailing Address
First Line	:	91 EAST AVE
Second Line	:
City	:	NORWALK
State	:	CT
Zip	:	06851-5020
Country	:	US
Telephone Number	:	203-855-9806
Fax Number	:	203-855-1135

Provider Business Practice Location Address
First Line	:	91 EAST AVE
Second Line	:
City	:	NORWALK
State	:	CT
Zip	:	06851-5020
Country	:	US
Telephone Number	:	203-855-9806
Fax Number	:	203-855-1135

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. CHUNG K SHIN M.D.” Practice Location

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