Provider Demographics
NPI:1437581980
Name:SHIN, MICHAEL MYUNGKEE (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MYUNGKEE
Last Name:SHIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8476 SIMMOND ST STE 5700
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY
Mailing Address - City:FORT GEORGE G MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-7084
Mailing Address - Country:US
Mailing Address - Phone:301-677-5922
Mailing Address - Fax:
Practice Address - Street 1:8476 SIMMOND ST STE 5700
Practice Address - Street 2:US ARMY DENTAL ACTIVITY
Practice Address - City:FORT GEORGE G MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-7084
Practice Address - Country:US
Practice Address - Phone:301-677-5922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA626561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice