Provider Demographics
NPI:1407826183
Name:SHIN, HAE WON (MD)
Entity Type:Individual
Prefix:
First Name:HAE WON
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:PO BOX 782743
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-2743
Mailing Address - Country:US
Mailing Address - Phone:602-910-6887
Mailing Address - Fax:215-612-5077
Practice Address - Street 1:10800 KNIGHTS RD
Practice Address - Street 2:ATTN: RADIOLOGY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-4200
Practice Address - Country:US
Practice Address - Phone:215-612-2610
Practice Address - Fax:215-612-5077
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067779L2085R0202X, 2085B0100X
NJ25MA081848002085R0202X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging