Provider Demographics
NPI:1821078478
Name:SHIN, JUNG S (MD)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:S
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:SAINT MARY'S MEDICAL CENTER
Mailing Address - Street 2:LANGHORNE-NEWTOWN CENTER
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047
Mailing Address - Country:US
Mailing Address - Phone:215-710-2161
Mailing Address - Fax:
Practice Address - Street 1:SAINT MARY'S MEDICAL CENTER
Practice Address - Street 2:LANGHORNE-NEWTOWN CENTER
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-710-2161
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT047566T207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI27869Medicare UPIN