Provider Demographics
NPI:1457792749
Name:MOON, SHINSIL (DDS)
Entity type:Individual
Prefix:
First Name:SHINSIL
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8924 RHYME CT
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3923
Mailing Address - Country:US
Mailing Address - Phone:703-477-0395
Mailing Address - Fax:870-779-0512
Practice Address - Street 1:2165 CUNNINGHAM DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2569
Practice Address - Country:US
Practice Address - Phone:757-827-5665
Practice Address - Fax:757-827-0121
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3956122300000X
VA04014146921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist