Daniel Edward Shin, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

12011064A Issued in IN

Practice address

1121 W Michigan Street
Ds307B
Indianapolis, IN 46202-5186

Phone

(317) 278-3632

Fax

(317) 274-2603

NPI assigned

Aug 26, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Periodontics

Education

Indiana University School of Dentistry, 2006

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• University of Utah Dental Services

  • Plastic and Reconstructive Surgery Physician
  • Salt Lake City, UT
  • NPI 1346633203
  Medicare reassignment
• University of Utah Dental Services

  • Dental Clinic/Center
  • Salt Lake City, UT
  • NPI 1447609631
  NPD
• University of Utah Dental Services

  • Dental Clinic/Center
  • Salt Lake City, UT
  • NPI 1821446279
  NPD

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

{
    "created_epoch": "1251244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479168000000",
    "number": "1770716607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 W MICHIGAN STREET",
            "address_2": "DS307B",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025186",
            "telephone_number": "317-278-3632",
            "fax_number": "317-274-2603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 W MICHIGAN STREET",
            "address_2": "DS307B",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025186",
            "telephone_number": "317-278-3632",
            "fax_number": "317-274-2603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIN",
        "first_name": "DANIEL",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-26",
        "last_updated": "2016-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": "052940",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IN",
            "license": "12011064A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ahmed A Shim, M.D.
• Tomoko Shimano, CMTPT, CMT
• Kim K Shimonek, NP
• Shimp Optical Corp
• Brian Chulmin Shin, MD
• Eric Youngyoon Shin, MD
• Ji Won Shin
• Steve S. Shin, MD
• Christina N. Shinaver, M.D.
• Shine Pediatric Therapy, LLC

• Periodontics in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Periodontics in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2016; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.