Provider Demographics
NPI:1275865222
Name:HYUN J. SHIN,
Entity Type:Organization
Organization Name:HYUN J. SHIN,
Other - Org Name:TOWNGATE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HYUN JOON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-697-7750
Mailing Address - Street 1:12625 FREDERICK ST
Mailing Address - Street 2:F-4
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5216
Mailing Address - Country:US
Mailing Address - Phone:951-697-7750
Mailing Address - Fax:
Practice Address - Street 1:12625 FREDERICK ST
Practice Address - Street 2:F-4
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5216
Practice Address - Country:US
Practice Address - Phone:951-697-7750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty