Active NPI
Jin Kyung Shin, DDS
- Dentist
- Loma Linda, CA
National Provider Identifier
1467790097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 62124
- Practice address
- 25829 Van Leuven St Apt 166
Loma Linda, CA 92354-2555 - Phone
- (909) 580-0599
- NPI assigned
- Jan 16, 2013
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 62124 | CA | Primary |
Addresses
Primary practice location
25829 Van Leuven St Apt 166
Loma Linda, CA 92354-2555
Mailing address
25829 Van Leuven St Apt 166
Loma Linda, CA 92354-2555
Phone (909) 580-0599
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 |
|---|---|---|---|
| 62124 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358294400000",
"number": "1467790097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25829 VAN LEUVEN ST APT 166",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923542555",
"telephone_number": "909-580-0599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25829 VAN LEUVEN ST APT 166",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923542555",
"telephone_number": "909-580-0599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIN",
"first_name": "JIN",
"middle_name": "KYUNG",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-01-16",
"last_updated": "2013-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "62124",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.