Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 110051 | NY |
NPI | 1114035029 |
---|---|
Provider Name | Mr. Choon S Shin |
First Address | Brooklyn, NY 11229 |
Second Address | Brooklyn, NY 11229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00196149 | (05) | NY |
C118217 | (02) |