Active NPI
Eun Sup Shin, D.M.D
- Dentist
- Seattle, WA
National Provider Identifier
1245672799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE60476969
- Practice address
- 1416 NW 46TH St Ste 106
Seattle, WA 98107-4622 - Phone
- (206) 783-0330
- NPI assigned
- Jul 25, 2013
- Last updated
- Oct 31, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE60476969 | WA | Primary |
| General Practice Dentistry | 1223G0001X | DN1856359 | MA |
Addresses
Primary practice location
1416 NW 46TH St Ste 106
Seattle, WA 98107-4622
Mailing address
2550 3Rd Ave Apt 112
Seattle, WA 98121-1490
Phone (805) 231-6067
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 |
|---|---|---|---|
| DE60476969 | WA | MD | Dentist |
| DN1856359 | MA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Washington Dental Corporation, PC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Ballard Modern Dentistry
- General Practice Dentistry
- Seattle, WA
- NPI 1669858122
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477872000000",
"number": "1245672799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2550 3RD AVE APT 112",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981211490",
"telephone_number": "805-231-6067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1416 NW 46TH ST STE 106",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981074622",
"telephone_number": "206-783-0330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIN",
"first_name": "EUN SUP",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-07-25",
"last_updated": "2016-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE60476969",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "DN1856359",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.