Provider Demographics
NPI:1649743733
Name:SHIN, HYUN JIN
Entity Type:Individual
Prefix:
First Name:HYUN JIN
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 PROMENADE BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2777
Mailing Address - Country:US
Mailing Address - Phone:201-590-2884
Mailing Address - Fax:
Practice Address - Street 1:535 E CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2922
Practice Address - Country:US
Practice Address - Phone:201-447-2020
Practice Address - Fax:201-447-3253
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03985200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist