Provider Demographics
NPI:1336431709
Name:DENTAL GROUP OF DONG SHIN, DDS, INC.
Entity Type:Organization
Organization Name:DENTAL GROUP OF DONG SHIN, DDS, INC.
Other - Org Name:FREMONT DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONG-YOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-499-8938
Mailing Address - Street 1:40803 FREMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-933-0088
Mailing Address - Fax:510-933-0080
Practice Address - Street 1:40803 FREMONT BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-933-0088
Practice Address - Fax:510-933-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty