Leo S Shin, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

61430 Issued in CA

Practice address

1401 Avocado Ave Ste 701
Newport Beach, CA 92660-8709

Phone

(949) 648-2202

NPI assigned

Jul 27, 2012

Last updated

Mar 28, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stromberg Dental Corporation

  dba Desert Valley Dental Group

  • General Practice Dentistry
  • Victorville, CA
  • NPI 1619073426
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522195200000",
    "number": "1003162066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 AVOCADO AVE STE 701",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926608709",
            "telephone_number": "949-648-2202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 AVOCADO AVE STE 701",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926608709",
            "telephone_number": "949-648-2202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13622 Bear Valley Rd Ste 10",
            "address_purpose": "LOCATION",
            "city": "Victorville",
            "state": "CA",
            "postal_code": "923928509",
            "country_code": "US",
            "telephone_number": "760-245-2010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIN",
        "first_name": "LEO",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-27",
        "last_updated": "2018-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "61430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natasha Ly Shih, PHARMD, MPH
• Matthew I Shihab
• Tiffany Shimizu
• Christina J Shin, DDS
• Jae Hyun Shin, M.D.
• Lexa Shoar
• Shohet Ear Associates Medical Group Inc
• Jack A Shohet, M.D.
• Pedram Shojai, L.AC.
• Sholeh Shahinfar, Speech Language Pathology Inc (Valued Voices)

• General Practice Dentistry in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.