Provider Demographics
NPI:1932546082
Name:SHIN, TAI HO (MD)
Entity Type:Individual
Prefix:
First Name:TAI HO
Middle Name:
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5290 MILITARY RD STE 8
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1953
Mailing Address - Country:US
Mailing Address - Phone:716-298-8440
Mailing Address - Fax:716-961-1271
Practice Address - Street 1:5290 MILITARY RD STE 8
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1953
Practice Address - Country:US
Practice Address - Phone:716-298-8440
Practice Address - Fax:716-961-1271
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296819207R00000X, 208M00000X, 207RE0101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program