Bryan Iksu Shin, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE61103820 Issued in WA

Practice address

927 128TH St SW
Everett, WA 98204-6315

Phone

(425) 290-6967

NPI assigned

Sep 20, 2018

Last updated

Jun 22, 2022By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• WA PPO C-SNP

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.

• Bryan Shin, DDS, PLLC

  • General Practice Dentistry
  • Kent, WA
  • NPI 1487385175
  NPD Authorized official

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

{
    "created_epoch": "1537401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1023592490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12721 192ND PL E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983918362",
            "telephone_number": "614-364-1695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "927 128TH ST SW",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982046315",
            "telephone_number": "425-290-6967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIN",
        "first_name": "BRYAN",
        "middle_name": "IKSU",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-20",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.025406",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE61103820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meron Shiferaw, PHARMD
• Annette Shifflett, LPN
• Tasneem Abbas Shikary, MD
• Korri Starsha Shimizu
• Shauna Shimono
• Hyunok Sarah Shin, PHARM.D
• Joo Eun Shin
• Mun A Shin, D.M.D
• Fatema Shipchandler, MD
• Anthony Berl Shipman, MA

• General Practice Dentistry in Everett, WA
• Providers in Everett, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2022; 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.