Provider Demographics
NPI:1689638702
Name:SHIN, HANG-JIN H (MD)
Entity Type:Individual
Prefix:DR
First Name:HANG-JIN
Middle Name:H
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 1:13011 S 104TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1508
Mailing Address - Country:US
Mailing Address - Phone:708-478-3600
Mailing Address - Fax:708-478-3552
Practice Address - Street 1:11560 S KEDZIE AVE STE 100
Practice Address - Street 2:
Practice Address - City:MERRIONETTE PARK
Practice Address - State:IL
Practice Address - Zip Code:60803-4517
Practice Address - Country:US
Practice Address - Phone:708-824-1114
Practice Address - Fax:708-824-9341
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097618207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL060058090OtherRAILROAD MEDICARE KANKAKE
ILCG1672OtherRAILDOAD MEDICARE GROUP PTAN NUMBER
IL036097618Medicaid
IL060048992OtherRAILROAD MEDICARE COOK
IL236551OtherMEDICARE GROUP
IL060053213OtherRAILROAD MEDICARE WILL
ILL64345OtherMEDICARE INDIVIDUAL PTAN
ILL77498OtherMEDICARE INDIVIDUAL PTAN
IL1508810086OtherGROUP NPI
IL416810OtherMEDICARE GROUP
IL01621208OtherBLUECROSS BLUE SHIELD
IL236550OtherMEDICARE GROUP
ILCN2703OtherRAILROAD MEDICARE GROUP PTAN NUMBER
ILL68230OtherMEDICARE INDIVIDUAL PTAN
ILCD8033OtherRAILROAD MEDICARE GROUP PTAN NUMBER
F77660Medicare UPIN