Active NPI
Lucas Kwangsu Shin, DMD
- Prosthodontics
- Fayetteville, NC
National Provider Identifier
1467916478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 11976
- Practice address
- 2300 Ramsey St
Fayetteville, NC 28301-3856 - Phone
- (910) 822-7029
- Fax
- (910) 482-5050
- NPI assigned
- Jan 23, 2019
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Prosthodontics | 1223P0700X | 11976 | NC | Primary |
Addresses
Primary practice location
2300 Ramsey St
Fayetteville, NC 28301-3856
Mailing address
2300 Ramsey St
Fayetteville, NC 28301-3856
Phone (910) 822-7029
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 |
|---|---|---|---|
| 11976 | NC | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745452800000",
"number": "1467916478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300 RAMSEY ST",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283013856",
"telephone_number": "910-822-7029",
"fax_number": "910-482-5050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 RAMSEY ST",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283013856",
"telephone_number": "910-822-7029",
"fax_number": "910-482-5050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIN",
"first_name": "LUCAS",
"middle_name": "KWANGSU",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-01-23",
"last_updated": "2025-04-24",
"certification_date": "2025-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "NC",
"license": "11976",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.