Provider Demographics
NPI:1114248127
Name:SHIN, MUN A (DMD)
Entity Type:Individual
Prefix:
First Name:MUN
Middle Name:A
Last Name:SHIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 128TH ST SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-6315
Mailing Address - Country:US
Mailing Address - Phone:425-290-6967
Mailing Address - Fax:
Practice Address - Street 1:927 128TH ST SW
Practice Address - Street 2:SUITE A
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-6315
Practice Address - Country:US
Practice Address - Phone:425-290-6967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60460517122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist