Active NPI
Michelle Shin, DDS, MSD
- Pediatric Dentistry
- Redlands, CA
National Provider Identifier
1386052306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 61747
- Practice address
- 308 W State St Ste 4a
Redlands, CA 92373-4626 - Phone
- (909) 798-2755
- NPI assigned
- Jul 23, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 61747 | CA | Primary |
Addresses
Primary practice location
308 W State St Ste 4a
Redlands, CA 92373-4626
Mailing address
4980 Barranca Pkwy Ste 101
Irvine, CA 92604-8654
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170719003895 | CA | Order and Referring Only - Dentist | 2567732803 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61747 | CA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406073600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406073600000",
"number": "1386052306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4980 BARRANCA PKWY STE 101",
"city": "IRVINE",
"state": "CA",
"postal_code": "926048654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "308 W STATE ST STE 4A",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923734626",
"telephone_number": "909-798-2755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIN",
"first_name": "MICHELLE",
"credential": "DDS, MSD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-07-23",
"last_updated": "2014-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "61747",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redlands, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2014; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.