Jeeyong Shin, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

245 Chapman St Ste 300
Providence, RI 02905-4539

Phone

(401) 444-4741

Fax

(401) 444-4445

NPI assigned

Jun 10, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in RI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1717977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1750123741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 CHAPMAN ST STE 300",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054539",
            "telephone_number": "401-444-4741",
            "fax_number": "401-444-4445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 CHAPMAN ST STE 300",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054539",
            "telephone_number": "401-444-4741",
            "fax_number": "401-444-4445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIN",
        "first_name": "JEEYONG",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-10",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Rose Shih, MD
• David Jaekwang Shim, M.D./PH.D.
• Aaron Kyunghoon Shin, DDS
• Ahram Shin
• Jaewook Shin
• Victor H Shin, M.D.
• Julia Kristine Shinnick, MD
• Ship
• Michael Macalister Shipp, MD
• Shira Hirshberg

• Student in an Organized Health Care Education/Training Program in Providence, RI
• Providers in Providence, RI by specialty
• Student in an Organized Health Care Education/Training Program in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.

Verify at the official NPI Registry.