Provider Demographics
NPI:1205967171
Name:SHIN, SANG Y (DMD)
Entity type:Individual
Prefix:DR
First Name:SANG
Middle Name:Y
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 1:1778 N PARK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6504
Mailing Address - Country:US
Mailing Address - Phone:407-647-2131
Mailing Address - Fax:407-645-5161
Practice Address - Street 1:1778 N PARK AVE STE 100
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-6504
Practice Address - Country:US
Practice Address - Phone:407-647-2131
Practice Address - Fax:407-645-5161
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL158911223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics