Marie Wonkyong Shin, DPM

Primary specialty

Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X

License

5711 Issued in CA

Practice address

12665 Garden Grove Blvd Ste 203
Garden Grove, CA 92843-1916

Phone

(714) 620-4699

Fax

(888) 866-7055

NPI assigned

Apr 28, 2011

Sex

Female

Sole proprietor

Yes

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

Enrolled in NJ, CA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Podiatry

Education

Barry University School of Podiatric Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gracelight Community HealthGroup PAC ID 3072619618, 24 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Good People Home Health, Inc. Home health agency, Fullerton, CA, CCN 757253

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Garden Grove Podiatry

  • Foot & Ankle Surgery Podiatrist
  • Garden Grove, CA
  • NPI 1447847546
  Medicare reassignment NPD Authorized official
• Gracelight Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1104075282
  Medicare reassignment Care Compare group NPD
• Optum Medical Care of New Jersey PC

  • Pediatrics Physician
  • New Hyde Park, NY
  • NPI 1578665048

  NJ

  Medicare reassignment NPD
• Gracelight Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1639241888
  NPD
• Optum Medical Care of New Jersey PC

  • Durable Medical Equipment & Medical Supplies
  • Belleville, NJ
  • NPI 1255050902
  NPD
• Quantum Business Development,Inc

  • Podiatrist
  • Hialeah, FL
  • NPI 1720344419

  Foot & Ankle Surgery

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Good People Home Health Inc.

  • Home Health Agency
  • Fullerton, CA
  • NPI 1982356648
  Care Compare affiliation

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

{
    "created_epoch": "1303948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756166400000",
    "number": "1275824971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12665 GARDEN GROVE BLVD STE 203",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431916",
            "telephone_number": "714-620-4699",
            "fax_number": "888-866-7055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12665 GARDEN GROVE BLVD STE 203",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431916",
            "telephone_number": "714-620-4699",
            "fax_number": "888-866-7055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4816 E 3rd St",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900221602",
            "country_code": "US",
            "telephone_number": "323-780-4510",
            "fax_number": "323-669-4346",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIN",
        "first_name": "MARIE",
        "middle_name": "WONKYONG",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-04-28",
        "last_updated": "2025-08-26",
        "certification_date": "2025-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "5711",
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "CA",
            "license": "5711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Shin
• Dong Joo Shin
• Jieun Shin
• John Sanghyun Shin, DISPENSER
• Kevin Y Shin, DC
• Sang Yun Shin, L.AC.
• Young Kyu Shin, DC
• Young SE Shin, L. AC.
• David Shipman
• Sora Shiraki

• Primary Podiatric Medicine Podiatrist in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Primary Podiatric Medicine Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.