Provider Demographics
NPI:1730207143
Name:SHIN, CHANG B (MD)
Entity type:Individual
Prefix:DR
First Name:CHANG
Middle Name:B
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4300 TALBOT RD S
Mailing Address - Street 2:SUITE 303
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6238
Mailing Address - Country:US
Mailing Address - Phone:425-228-7446
Mailing Address - Fax:425-277-4746
Practice Address - Street 1:4300 TALBOT RD S
Practice Address - Street 2:SUITE 303
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6238
Practice Address - Country:US
Practice Address - Phone:425-228-7446
Practice Address - Fax:425-277-4746
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000181972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA129032OtherL&I PROVIDER NUMBER