Provider Demographics
NPI:1205470010
Name:SHIN, JOSEPH KYUNGHWAN (APRN)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KYUNGHWAN
Last Name:SHIN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:KYUNG
Other - Middle Name:HWAN
Other - Last Name:SHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:P O BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4000
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX407793502OtherMEDICAID CSHCN
TX407793501Medicaid
TX8MH314OtherBCBS
TXP02540105OtherRAILROAD MEDICARE