Edward Jaywon Shin, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

245696-1 Issued in NY

Practice address

436 Red Wing Dr
Alamo, CA 94507-2710

Phone

(646) 418-3015

NPI assigned

Mar 15, 2012

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1331769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652832000000",
    "number": "1851666341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "436 RED WING DR",
            "city": "ALAMO",
            "state": "CA",
            "postal_code": "945072710",
            "telephone_number": "646-418-3015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 RED WING DR",
            "city": "ALAMO",
            "state": "CA",
            "postal_code": "945072710",
            "telephone_number": "646-418-3015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIN",
        "first_name": "EDWARD",
        "middle_name": "JAYWON",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-15",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "177737",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "245696-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samamesh LLC (New Alamo Residence Home)
• Stephen Michael Schwarcz, D.D.S.
• Monica Lacey Seiber, R.D.
• Shalini Mongia
• Tara Shelby
• Shiv Behavioral Health Inc
• Daljeet Singh, MD
• Site for Sight Optometry, Inc.
• Daniel Stuart Smith, DC
• Tilden Sokoloff, DPM

• Internal Medicine Physician in Alamo, CA
• Providers in Alamo, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2022; 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.