MEDICARE: HYUNGKYUN SHIN DDS

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	1223P0700X	Prosthodontics	RES.005035	OH

General Provider Information

NPI Number	:	1568304053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYUNGKYUN SHIN DDS

Provider Business Mailing Address
First Line	:	19 MAHAN ST
Second Line	:
City	:	TENAFLY
State	:	NJ
Zip	:	07670-1821
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 W 12TH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1267
Country	:	US
Telephone Number	:	614-292-5398
Fax Number	:

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

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “ HYUNGKYUN SHIN DDS” Practice Location

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