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NPI Code Detail

MEDICARE: JAE Y SHIN MD

MEDICARE: JAE Y SHIN MD
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
1207R00000XInternal Medicine PhysicianME94179FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ME94179OTHERFLSTATE MED.LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619064326
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAE Y SHIN MD
Provider Business Mailing Address
First Line : 3030 N ROCKY POINT DR W
Second Line : SUITE 670
City : TAMPA
State : FL
Zip : 33607-5906
Country : US
Telephone Number : 813-289-6597
Fax Number : 813-289-6592
Provider Business Practice Location Address
First Line : 3030 N ROCKY POINT DR W
Second Line : SUITE 670
City : TAMPA
State : FL
Zip : 33607-5906
Country : US
Telephone Number : 813-289-6597
Fax Number : 813-289-6592
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2006
Last Update Date : 03/17/2015

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