Provider Demographics
NPI:1821118811
Name:SHIN, VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
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 1:1820 PRESTON PARK BLVD
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3656
Mailing Address - Country:US
Mailing Address - Phone:972-696-9565
Mailing Address - Fax:
Practice Address - Street 1:1820 PRESTON PARK BLVD
Practice Address - Street 2:SUITE 1200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3656
Practice Address - Country:US
Practice Address - Phone:972-696-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2264032085R0202X
TXM96512085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY914T11OtherMEDICARE
NY02825721Medicaid
NY914T11Medicare PIN