Provider Demographics
NPI:1346238771
Name:SHIN, KYUN (M D)
Entity Type:Individual
Prefix:DR
First Name:KYUN
Middle Name:
Last Name:SHIN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MAPLE AVE. STE 5-C
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1729
Mailing Address - Country:US
Mailing Address - Phone:732-747-0513
Mailing Address - Fax:
Practice Address - Street 1:130 MAPLE AVE STE 5C
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1729
Practice Address - Country:US
Practice Address - Phone:732-747-0513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA026879002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1391902Medicaid
NJD96743Medicare ID - Type Unspecified
NJ1391902Medicaid