Provider Demographics
NPI:1013298074
Name:SHIN, JAI WOOK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAI
Middle Name:WOOK
Last Name:SHIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:790 NORTHERN BLVD
Mailing Address - Street 2:ABINGTON PROFESSIONAL PLAZA SUITE L
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-8799
Mailing Address - Country:US
Mailing Address - Phone:570-586-9717
Mailing Address - Fax:570-586-5446
Practice Address - Street 1:790 NORTHERN BLVD
Practice Address - Street 2:ABINGTON PROFESSIONAL PLAZA SUITE L
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-8799
Practice Address - Country:US
Practice Address - Phone:570-586-9717
Practice Address - Fax:570-586-5446
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS038894122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist