Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN1856738 | MA |
N | 1223P0700X | Prosthodontist | 058971 | NY |
Y | 1223P0700X | Prosthodontist | 16910 | MD |
N | 1223P0700X | Prosthodontist | 22DI02752000 | NJ |
NPI | 1235532292 |
---|---|
Provider Name | Dr. Dong-Jin Shin |
First Address | Washington, DC 20009-1744 |
Second Address | North Bethesda, MD 20852-4823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2014 |
Last Update Date | 05/01/2022 |