Provider Demographics
NPI:1174925770
Name:HYUN SHIN, DDS., INC.
Entity type:Organization
Organization Name:HYUN SHIN, DDS., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HYUN JOON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-245-7083
Mailing Address - Street 1:17100 BEAR VALLEY RD
Mailing Address - Street 2:SUITE N
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5853
Mailing Address - Country:US
Mailing Address - Phone:760-245-7083
Mailing Address - Fax:
Practice Address - Street 1:17100 BEAR VALLEY RD
Practice Address - Street 2:SUITE N
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5853
Practice Address - Country:US
Practice Address - Phone:760-245-7083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB44361-01OtherDENTI-CAL