Provider Demographics
NPI:1851395115
Name:SHIN, DAVID JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSEPH
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 1:14027 MEMORIAL DR
Mailing Address - Street 2:STE 304
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-6826
Mailing Address - Country:US
Mailing Address - Phone:281-392-3100
Mailing Address - Fax:281-392-4287
Practice Address - Street 1:14811 SAINT MARYS LN
Practice Address - Street 2:STE 168
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2916
Practice Address - Country:US
Practice Address - Phone:281-392-3100
Practice Address - Fax:281-392-4287
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00RL02Medicaid
TXP00RL02Medicaid
TXRL02Medicare ID - Type Unspecified