Provider Demographics
NPI:1679034979
Name:SHIN, EUISUNG (MD, MPH, MS)
Entity type:Individual
Prefix:
First Name:EUISUNG
Middle Name:
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD, MPH, MS
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:SHIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MPH, MS
Mailing Address - Street 1:4755 OGLETOWN STANTON RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19718-2200
Mailing Address - Country:US
Mailing Address - Phone:302-733-1000
Mailing Address - Fax:
Practice Address - Street 1:4755 OGLETOWN STANTON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-733-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2025-06-16
Deactivation Date:2025-04-14
Deactivation Code:
Reactivation Date:2025-06-10
Provider Licenses
StateLicense IDTaxonomies
1744R1102X, 1744R1103X
DEC7-0018984390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1744R1102XOther Service ProvidersSpecialistResearch Study
No1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder