Provider Demographics
NPI:1770736399
Name:YONG J SHIN D.D.S. INC,
Entity type:Organization
Organization Name:YONG J SHIN D.D.S. INC,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
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:DDS
Authorized Official - Phone:760-244-4844
Mailing Address - Street 1:16922 MAIN ST STE F
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-6011
Mailing Address - Country:US
Mailing Address - Phone:760-244-4844
Mailing Address - Fax:760-244-5002
Practice Address - Street 1:16922 MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-6011
Practice Address - Country:US
Practice Address - Phone:760-244-4844
Practice Address - Fax:760-244-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49670261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA49670OtherCALIFORNIA DENTIST LISENCE