Provider Demographics
NPI:1366693988
Name:SHIN, JA HYUN (MD)
Entity Type:Individual
Prefix:
First Name:JA HYUN
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 ROCHAMBEAU AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2836
Mailing Address - Country:US
Mailing Address - Phone:718-430-3204
Mailing Address - Fax:718-430-8750
Practice Address - Street 1:3332 ROCHAMBEAU AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2836
Practice Address - Country:US
Practice Address - Phone:718-430-3204
Practice Address - Fax:718-430-8750
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY251970207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03243836Medicaid
NY03243836Medicaid