Grace Eun Jin Shin, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

049968 Issued in NY

Practice address

4823 Little Neck Pkwy
Little Neck, NY 11362-1432

Phone

(718) 281-1282

Fax

(718) 281-2229

NPI assigned

Oct 19, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Modern E Dental

  • General Practice Dentistry
  • Little Neck, NY
  • NPI 1104090471
  NPD (past) Authorized official
• Joseph P. Addabbo Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ozone Park, NY
  • NPI 1134476443
  NPD (past)

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295724565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4823 LITTLE NECK PKWY",
            "city": "LITTLE NECK",
            "state": "NY",
            "postal_code": "113621432",
            "telephone_number": "718-281-1282",
            "fax_number": "718-281-2229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4823 LITTLE NECK PKWY",
            "city": "LITTLE NECK",
            "state": "NY",
            "postal_code": "113621432",
            "telephone_number": "718-281-1282",
            "fax_number": "718-281-2229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIN",
        "first_name": "GRACE",
        "middle_name": "EUN JIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "049968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Seoul Physical Therapy
• Seoul Physical Therapy P.C
• Paul Sforza, M.D.
• Sharon Greenberg, MD PC
• Myung Seok Shim
• Sally Shin, OTR/L
• Victoria Shin, LMHC
• Roman Shinder, MD
• Linda Sheryl Siegel, DDS
• Silverlife NP in Adult Health P.C.

• General Practice Dentistry in Little Neck, NY
• Providers in Little Neck, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.