Active NPI
David Shin
- Endodontics
- Philadelphia, PA
National Provider Identifier
1194173377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 22DI02674100
- Practice address
- 3945 Chestnut St Apt 405
Philadelphia, PA 19104-3626 - Phone
- (903) 241-2489
- NPI assigned
- May 29, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 22DI02674100 | NJ | Primary |
Addresses
Primary practice location
3945 Chestnut St Apt 405
Philadelphia, PA 19104-3626
Mailing address
3945 Chestnut St Apt 405
Philadelphia, PA 19104-3626
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 |
|---|---|---|---|
| 22DI02674100 | NJ | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578960000000",
"number": "1194173377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3945 CHESTNUT ST APT 405",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191043626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3945 CHESTNUT ST APT 405",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191043626",
"telephone_number": "903-241-2489"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIN",
"first_name": "DAVID",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-29",
"last_updated": "2020-01-14",
"certification_date": "2020-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NJ",
"license": "22DI02674100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.