Individual provider Active NPI

Haneul Shin

  • Dentist
  • Cupertino, CA
National Provider Identifier
1578335261
Registry record updated Oct 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
109397 Issued in CA
Practice address
10440 S de Anza Blvd Ste D1
Cupertino, CA 95014-3018
Phone
(408) 642-1775
NPI assigned
Oct 25, 2023
Last updated
Oct 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 25, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 109397 CA Primary

Addresses

Primary practice location

10440 S de Anza Blvd Ste D1
Cupertino, CA 95014-3018

Mailing address

355 1St St Unit S604
San Francisco, CA 94105-3045

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

NPI Registry JSON

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

{
    "created_epoch": "1698192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698192000000",
    "number": "1578335261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 1ST ST UNIT S604",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941053045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10440 S DE ANZA BLVD STE D1",
            "city": "CUPERTINO",
            "state": "CA",
            "postal_code": "950143018",
            "telephone_number": "408-642-1775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIN",
        "first_name": "HANEUL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-25",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "109397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cupertino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; 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.