Provider Demographics
NPI:1053461236
Name:SHIN, WILLIAM WOOSIK (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WOOSIK
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42-21 162 ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358
Mailing Address - Country:US
Mailing Address - Phone:718-463-0101
Mailing Address - Fax:718-460-2009
Practice Address - Street 1:4221 162ND ST
Practice Address - Street 2:#1B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-4150
Practice Address - Country:US
Practice Address - Phone:718-463-0101
Practice Address - Fax:718-460-2009
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222692208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02203249Medicaid
NY02203249Medicaid
H60723Medicare UPIN