Provider Demographics
NPI:1477395523
Name:SHIN, EVAN HOCHEUL (DDS)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:HOCHEUL
Last Name:SHIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 BERKELEY AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-7227
Mailing Address - Country:US
Mailing Address - Phone:734-709-5350
Mailing Address - Fax:
Practice Address - Street 1:8000 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8824
Practice Address - Country:US
Practice Address - Phone:219-356-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014482A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist