Provider Demographics
NPI:1881204717
Name:SHIN, SANG-OOK JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SANG-OOK
Middle Name:JOHN
Last Name:SHIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14960 SCARLET OAK TRL
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-4877
Mailing Address - Country:US
Mailing Address - Phone:440-292-6824
Mailing Address - Fax:
Practice Address - Street 1:8245 AUBURN RD
Practice Address - Street 2:
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-9786
Practice Address - Country:US
Practice Address - Phone:440-951-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026280122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist