Provider Demographics
NPI:1538827142
Name:JAE WOOK SHIN, D.M.D. P.C.
Entity type:Organization
Organization Name:JAE WOOK SHIN, D.M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAE
Authorized Official - Middle Name:WOOK
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-243-1023
Mailing Address - Street 1:222 W 14TH ST # 7MEZZ
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7200
Mailing Address - Country:US
Mailing Address - Phone:212-243-1023
Mailing Address - Fax:212-243-2510
Practice Address - Street 1:222 W 14TH ST # 7MEZZ
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7200
Practice Address - Country:US
Practice Address - Phone:212-243-1023
Practice Address - Fax:212-243-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental