Active NPI
Jun Soo Shin, DDS
- Dentist
- Chicago, IL
National Provider Identifier
1417615386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.031809
- Practice address
- 855 W Madison St Apt 506
Chicago, IL 60607-3137 - Phone
- (808) 426-3816
- NPI assigned
- Dec 7, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 021.003144 | IL | |
| Dentist | 122300000X | 019.031809 | IL | Primary |
Addresses
Primary practice location
855 W Madison St Apt 506
Chicago, IL 60607-3137
Mailing address
855 W Madison St Apt 506
Chicago, IL 60607-3137
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.031809 | IL | MD | Dentist |
| 021.003144 | IL | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638835200000",
"number": "1417615386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "855 W MADISON ST APT 506",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606073137"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "855 W MADISON ST APT 506",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606073137",
"telephone_number": "808-426-3816"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIN",
"first_name": "JUN SOO",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-12-07",
"last_updated": "2021-12-07",
"certification_date": "2021-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "IL",
"license": "021.003144",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.031809",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.