Provider Demographics
NPI:1982688511
Name:SHIN, MYUNG HYO (MD)
Entity Type:Individual
Prefix:
First Name:MYUNG
Middle Name:HYO
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:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-926-9010
Mailing Address - Fax:215-226-8285
Practice Address - Street 1:2301 E ALLEGHENY AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19134-4427
Practice Address - Country:US
Practice Address - Phone:215-969-3700
Practice Address - Fax:215-939-3703
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032923L207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3088OtherBRAVOH EALTH
PA000751133Medicaid
PA4101949OtherAETNA PPO
PAP425936OtherOXFORD
PA040414OtherKEYSTONE MERCY HEALTH
PA2Y3371OtherHEALTH NET
PA3303054OtherAETNA HMO
PA176437OtherHIGHMARK BLUE SHIELD
PA0052973000OtherINDEPENDENCE BLUE CROSS
PA0075113301OtherAMERICHOICE
PA160032948OtherRAILROAD MEDICARE
PA519057OtherCOVENTRY HEALTH AMERICA
PA176437Medicare PIN
PA0075113301OtherAMERICHOICE