Provider Demographics
NPI:1841228608
Name:SHIN, EON K (MD)
Entity Type:Individual
Prefix:
First Name:EON
Middle Name:K
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:834 CHESTNUT ST
Mailing Address - Street 2:SUITE G114
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5127
Mailing Address - Country:US
Mailing Address - Phone:215-521-3000
Mailing Address - Fax:215-521-3002
Practice Address - Street 1:834 CHESTNUT ST
Practice Address - Street 2:SUITE G114
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5127
Practice Address - Country:US
Practice Address - Phone:215-521-3000
Practice Address - Fax:215-521-3002
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA227333207X00000X
PAMD431878207XS0106X, 207X00000X
NJ25MA08306100207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00621736OtherRR MEDICARE
PA2010587OtherPBS
PA3318492000OtherINDEPENDENCE BLUE CROSS/KEYSTONE
PA2010587OtherPBS