Provider Demographics
NPI:1326241266
Name:SHIN, THOMAS WOO (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WOO
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 1:7895 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6665
Mailing Address - Country:US
Mailing Address - Phone:219-947-1910
Mailing Address - Fax:219-947-3117
Practice Address - Street 1:7895 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6665
Practice Address - Country:US
Practice Address - Phone:219-947-1910
Practice Address - Fax:219-947-3117
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01075481A208600000X
KY43723208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201309980Medicaid
KY7100137170Medicaid
OH3112072Medicaid
KY7100137170Medicaid
KYP400022597Medicare PIN
KYK007070Medicare PIN
IN201309980Medicaid