Dental Group of Dong Shin, DDS, Inc.

Primary specialty

DentistTaxonomy code 122300000X

License

57509 Issued in CA

Legal business name

DENTAL GROUP OF DONG SHIN, DDS, INC.

Doing business as

Fremont Dental Center

Practice address

40803 Fremont Blvd
Fremont, CA 94538

Phone

(510) 933-0088

Fax

(510) 933-0080

NPI assigned

May 4, 2011

Organization subpart

No

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

Authorized official

Name

Dong-Youn Shin, D.D.S.

Title

President Or Director

Phone

(408) 499-8938

Specialties & licenses 1

Addresses

Other names 1

• Fremont Dental Center Doing business as

Locations

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

{
    "created_epoch": "1304467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304726400000",
    "number": "1336431709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40803 FREMONT BLVD",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "94538",
            "telephone_number": "510-933-0088",
            "fax_number": "510-933-0080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40803 FREMONT BLVD",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "94538",
            "telephone_number": "510-933-0088",
            "fax_number": "510-933-0080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL GROUP OF DONG SHIN, DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-04",
        "last_updated": "2011-05-07",
        "status": "A",
        "authorized_official_last_name": "SHIN",
        "authorized_official_first_name": "DONG-YOUN",
        "authorized_official_title_or_position": "PRESIDENT OR DIRECTOR",
        "authorized_official_telephone_number": "408-499-8938",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "57509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fremont Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Fremont, CA
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• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2011; 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.