Provider Demographics
NPI:1255473575
Name:SHIN, CARL HYUN-GEOL (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:HYUN-GEOL
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2424 ARDEN WAY
Mailing Address - Street 2:STE 301
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2482
Mailing Address - Country:US
Mailing Address - Phone:916-977-0741
Mailing Address - Fax:916-977-0547
Practice Address - Street 1:2424 ARDEN WAY
Practice Address - Street 2:STE 301
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2482
Practice Address - Country:US
Practice Address - Phone:916-977-0741
Practice Address - Fax:916-977-0547
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60900208VP0014X, 208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG64120Medicare UPIN