Provider Demographics
NPI:1669894010
Name:SHIN, MIN
Entity type:Individual
Prefix:DR
First Name:MIN
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 N BROAD ST E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-8964
Mailing Address - Country:US
Mailing Address - Phone:919-639-2663
Mailing Address - Fax:
Practice Address - Street 1:5443 WADE PARK BLVD
Practice Address - Street 2:#1315
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6053
Practice Address - Country:US
Practice Address - Phone:919-360-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-18
Last Update Date:2014-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice