Provider Demographics
NPI:1558469452
Name:SHIN, HYON C (MD)
Entity Type:Individual
Prefix:
First Name:HYON
Middle Name:C
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HYON-HO
Other - Middle Name:
Other - Last Name:SHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9011 MOUNTAIN RIDGE DR STE 140
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7369
Mailing Address - Country:US
Mailing Address - Phone:512-443-5954
Mailing Address - Fax:512-326-3433
Practice Address - Street 1:9011 MOUNTAIN RIDGE DR STE 140
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7369
Practice Address - Country:US
Practice Address - Phone:512-443-5954
Practice Address - Fax:512-326-3433
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6724208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10012078OtherAMERIGROUP
TX0068EYOtherBCBS
TX057687OtherFIRSTCARE PIN
10619641OtherHEALTHSMART ID
5357727OtherAETNA
TXJ6724OtherLICENSE
TX123900100OtherFIRSTCARE ID
TX031274602Medicaid
TX123900100OtherFIRSTCARE ID
TXJ6724OtherLICENSE