Provider Demographics
NPI:1740693498
Name:YONG J. SHIN, D.D.S. INC
Entity type:Organization
Organization Name:YONG J. SHIN, D.D.S. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YONG J.
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:909-983-9325
Mailing Address - Street 1:1739 S EUCLID AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-5831
Mailing Address - Country:US
Mailing Address - Phone:909-983-9325
Mailing Address - Fax:909-467-9956
Practice Address - Street 1:1739 S EUCLID AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-5831
Practice Address - Country:US
Practice Address - Phone:909-983-9325
Practice Address - Fax:909-467-9956
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YONG J. SHIN, D.D.S. INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49670261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental