Provider Demographics
NPI:1679677165
Name:SHIN, HYUNKI (MD)
Entity Type:Individual
Prefix:
First Name:HYUNKI
Middle Name:
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2826 OLD LEE HWY
Mailing Address - Street 2:306
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4323
Mailing Address - Country:US
Mailing Address - Phone:703-204-0555
Mailing Address - Fax:703-204-0544
Practice Address - Street 1:2826 OLD LEE HWY
Practice Address - Street 2:306
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4323
Practice Address - Country:US
Practice Address - Phone:703-204-0555
Practice Address - Fax:703-204-0544
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA62-1457-6Medicaid
VA62-1457-6Medicaid
VAG02150M01Medicare ID - Type Unspecified