Provider Demographics
NPI:1063637718
Name:SHIN, INAI L (MD)
Entity Type:Individual
Prefix:DR
First Name:INAI
Middle Name:L
Last Name:SHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:210 COLUMBIA CLUB DR E
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-9478
Mailing Address - Country:US
Mailing Address - Phone:011-822-7917
Mailing Address - Fax:011-822-7913
Practice Address - Street 1:121CSH
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205
Practice Address - Country:KR
Practice Address - Phone:0118227-917-5545
Practice Address - Fax:0118227-913-7706
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCSC8488207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine