Provider Demographics
NPI:1528568821
Name:OCK, SHIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHIN
Middle Name:
Last Name:OCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SHIN
Other - Middle Name:OCK
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:11810 GRAND PARK AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-8679
Mailing Address - Country:US
Mailing Address - Phone:301-276-5468
Mailing Address - Fax:
Practice Address - Street 1:11810 GRAND PARK AVE STE 500
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-8679
Practice Address - Country:US
Practice Address - Phone:301-276-5468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11430103TC0700X
MD06851103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110171053AMedicaid