Kevin Daesu Shin, L.AC., PH.D.

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

202 Issued in NC

Practice address

706A N Reilly Rd
Fayetteville, NC 28303-5619

Phone

(910) 868-8865

NPI assigned

Sep 15, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Dae Su Shin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1252972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252972800000",
    "number": "1346573847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706A N REILLY RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035619",
            "telephone_number": "910-868-8865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706A N REILLY RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035619",
            "telephone_number": "910-868-8865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIN",
        "first_name": "KEVIN",
        "middle_name": "DAESU",
        "name_prefix": "Dr.",
        "credential": "L.AC., PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-09-15",
        "last_updated": "2009-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NC",
            "license": "202",
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "4641",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAE",
            "last_name": "SHIN",
            "middle_name": "SU",
            "prefix": "DR.",
            "credential": "L.AC., PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jena R Shields, M.S., CCC-SLP
• Kayla Shiggs
• Christa Shih
• Adi Shimoni, OTR/L
• Reina Shimozono, PHARMD
• Lucas Kwangsu Shin, DMD
• Shinelight, Inc
• Shining Star PLLC
• Ashleigh Danielle Shinkle, OTR/L
• Shipman-Fayetteville

• Acupuncturist in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Acupuncturist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2009; 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.