Provider Demographics
NPI:1750999736
Name:SHIN, KYUNGMIN (DDS)
Entity type:Individual
Prefix:DR
First Name:KYUNGMIN
Middle Name:
Last Name:SHIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:LUKE
Other - Middle Name:
Other - Last Name:SHIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:11 S EUTAW ST APT 1609
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1638
Mailing Address - Country:US
Mailing Address - Phone:410-240-8125
Mailing Address - Fax:
Practice Address - Street 1:2984 SIDNEY ST APT 329
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-5148
Practice Address - Country:US
Practice Address - Phone:410-240-8125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17006122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist