Provider Demographics
NPI:1972009231
Name:SHIN, HYUNJUNG (DNP, AGPCNP-C)
Entity Type:Individual
Prefix:
First Name:HYUNJUNG
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:DNP, AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 S STATE ST UNIT 1306
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3579
Mailing Address - Country:US
Mailing Address - Phone:312-731-6287
Mailing Address - Fax:
Practice Address - Street 1:1100 W CERMAK RD # 116
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4500
Practice Address - Country:US
Practice Address - Phone:312-243-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017387363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner