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NPI Code Detail

MEDICARE: JISOO SHIN D.D.S.

MEDICARE: JISOO SHIN D.D.S.
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
11223G0001XGeneral Practice Dentistry010451CT
21223G0001XGeneral Practice Dentistry27922TX
31223G0001XGeneral Practice Dentistry055644NY

General Provider Information

NPI Number : 1952698615
Entity Type Code : Individual
Provider Name (Legal Business Name) : JISOO SHIN D.D.S.
Provider Business Mailing Address
First Line : 1799 N FRY RD
Second Line :
City : KATY
State : TX
Zip : 77449-3347
Country : US
Telephone Number : 917-748-5926
Fax Number :
Provider Business Practice Location Address
First Line : 6295 BISSONNET ST
Second Line :
City : HOUSTON
State : TX
Zip : 77081-6809
Country : US
Telephone Number : 713-777-1313
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2011
Last Update Date : 07/29/2015

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Directions to “ JISOO SHIN D.D.S.” Practice Location

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