Michael J Shin, D.D.S.
Individual provider Active NPI Dentist · Rio Dell, CA
NPI 1306964754 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1306964754
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 46965 (CA)
- Practice address
- 10 Belleview Ave
Rio Dell, CA 95562-1027 - Phone
- (707) 764-5164
- NPI assigned
- Mar 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160412002755 | CA | Order and Referring Only - Other (Non-Physician) | 9739487489 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46965 | CA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 46965 | CA | Yes |
Addresses
Primary practice location
10 Belleview Ave
Rio Dell, CA 95562-1027
Mailing address
10 Belleview Ave
Rio Dell, CA 95562-1027
Phone (707) 764-5164
Other providers in Rio Dell, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.