NPIMap

Organization Active NPI

Sang G Shin, DDS, Inc.

  • Dentist
  • Moreno Valley, CA
National Provider Identifier
1821425232
Registry record updated Sep 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
59863 Issued in CA
Legal business name
SANG G SHIN, DDS, INC.
Practice address
12625 Frederick St
F-4
Moreno Valley, CA 92553-5216
Phone
(951) 697-7750
Fax
(951) 697-7752
NPI assigned
Sep 30, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2013

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

Authorized official

Name
Dr. Sang Gyu Shin
Title
Ceo
Phone
(951) 697-7750

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 59863 CA Primary

Addresses

Primary practice location

12625 Frederick St
F-4
Moreno Valley, CA 92553-5216

Mailing address

12625 Frederick St
F-4
Moreno Valley, CA 92553-5216
Phone (951) 697-7750

National Provider Directory

National Provider Directory

Locations

12625 Frederick St
Ste F4
Moreno Valley, CA 92553
Phone (951) 697-7750

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1380499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380499200000",
    "number": "1821425232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12625 FREDERICK ST",
            "address_2": "F-4",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925535216",
            "telephone_number": "951-697-7750",
            "fax_number": "951-697-7752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12625 FREDERICK ST",
            "address_2": "F-4",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925535216",
            "telephone_number": "951-697-7750",
            "fax_number": "951-697-7752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANG G SHIN, DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-30",
        "last_updated": "2013-09-30",
        "status": "A",
        "authorized_official_last_name": "SHIN",
        "authorized_official_first_name": "SANG GYU",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "951-697-7750",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "59863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moreno Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.

Verify at the official NPI Registry.