Provider Demographics
NPI:1669620142
Name:SHIN, JAE HYUN (MD)
Entity type:Individual
Prefix:DR
First Name:JAE
Middle Name:HYUN
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 1:33 LACEBARK
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2243
Mailing Address - Country:US
Mailing Address - Phone:585-478-4654
Mailing Address - Fax:
Practice Address - Street 1:320 SUPERIOR AVE STE 370
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2795
Practice Address - Country:US
Practice Address - Phone:949-515-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC196708207RI0200X
VA0101264970207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease