Active NPI
Keaton Shin
- Pediatric Dentistry
- Pflugerville, TX
National Provider Identifier
1073131587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 37206
- Practice address
- 17315 Arcata Ave
Pflugerville, TX 78660-6218 - Phone
- (512) 484-9161
- NPI assigned
- Jul 10, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 37206 | TX | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatric Dentistry | 1223P0221X | 37206 | TX | Primary |
Addresses
Primary practice location
17315 Arcata Ave
Pflugerville, TX 78660-6218
Mailing address
17315 Arcata Ave
Pflugerville, TX 78660-6218
Phone (512) 484-9161
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37206 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705622400000",
"number": "1073131587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17315 ARCATA AVE",
"city": "PFLUGERVILLE",
"state": "TX",
"postal_code": "786606218",
"telephone_number": "512-484-9161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17315 ARCATA AVE",
"city": "PFLUGERVILLE",
"state": "TX",
"postal_code": "786606218",
"telephone_number": "512-484-9161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIN",
"first_name": "KEATON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-07-10",
"last_updated": "2024-01-19",
"certification_date": "2024-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "37206",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "TX",
"license": "37206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pflugerville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.