Provider Demographics
NPI:1396950309
Name:SHIN, JOHN SHANGKYUN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:SHANGKYUN
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:319 COURT SQ
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-5658
Mailing Address - Country:US
Mailing Address - Phone:919-292-1464
Mailing Address - Fax:919-292-1471
Practice Address - Street 1:319 COURT SQ
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5658
Practice Address - Country:US
Practice Address - Phone:919-292-1464
Practice Address - Fax:919-292-1471
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2001002792084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH76766Medicare UPIN