Jai Wook Shin, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DS038894 Issued in PA

Practice address

790 Northern Blvd
Abington Professional Plaza Suite L
South Abington Township, PA 18411-8799

Phone

(570) 586-9717

Fax

(570) 586-5446

NPI assigned

Sep 6, 2011

Sex

Male

Sole proprietor

Yes

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

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

{
    "created_epoch": "1315267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345075200000",
    "number": "1013298074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 NORTHERN BLVD",
            "address_2": "ABINGTON PROFESSIONAL PLAZA SUITE L",
            "city": "SOUTH ABINGTON TOWNSHIP",
            "state": "PA",
            "postal_code": "184118799",
            "telephone_number": "570-586-9717",
            "fax_number": "570-586-5446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 NORTHERN BLVD",
            "address_2": "ABINGTON PROFESSIONAL PLAZA SUITE L",
            "city": "SOUTH ABINGTON TOWNSHIP",
            "state": "PA",
            "postal_code": "184118799",
            "telephone_number": "570-586-9717",
            "fax_number": "570-586-5446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIN",
        "first_name": "JAI",
        "middle_name": "WOOK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-06",
        "last_updated": "2012-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS038894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in South Abington Township, PA
• Providers in South Abington Township, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2012; 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.