Provider Demographics
NPI:1558419333
Name:SHIN, HYUN JIN (MD)
Entity Type:Individual
Prefix:DR
First Name:HYUN
Middle Name:JIN
Last Name:SHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HYUN
Other - Middle Name:JIN
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7405 SHALLOWFORD RD STE 270
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2662
Mailing Address - Country:US
Mailing Address - Phone:423-602-9545
Mailing Address - Fax:
Practice Address - Street 1:7405 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2661
Practice Address - Country:US
Practice Address - Phone:423-605-9545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072369A208000000X
CAA74088208000000X
TN64599208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201209230Medicaid
IN000000879383OtherBCBS BMG PEDIATRICS BRISTOL ST