Provider Demographics
NPI:1639335060
Name:SHIN, PETER HUN (DO)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:HUN
Last Name:SHIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 COLETTA CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 SEYMOUR ST BLDG 502
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06102-8000
Practice Address - Country:US
Practice Address - Phone:186-097-2054
Practice Address - Fax:860-545-5221
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT69857207R00000X
CODR.0050005207R00000X
CA20A19217207R00000X
MT143638207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODR.0050005OtherSTATE LICENSE
CA20A19217OtherSTATE LICENSE