Provider Demographics
NPI:1235532292
Name:SHIN, DONG-JIN (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:DONG-JIN
Middle Name:
Last Name:SHIN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 FLORIDA AVE NW APT 401
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-1744
Mailing Address - Country:US
Mailing Address - Phone:857-540-2066
Mailing Address - Fax:
Practice Address - Street 1:5904 HUBBARD DR
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-4823
Practice Address - Country:US
Practice Address - Phone:301-377-8306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0589711223P0700X
MADN1856738122300000X
NJ22DI027520001223P0700X
MD169101223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist