SE Jung Shin, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

MD00038373 Issued in WA

Practice address

10555 SE Carr Rd BLDG M
Renton, WA 98055-5820

Phone

(425) 656-4270

Fax

(425) 656-4271

NPI assigned

Jan 27, 2006

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

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Cowiche Creek Emergency Physicians

  • Emergency Medicine Physician
  • Yakima, WA
  • NPI 1285683425
  NPD (past)
• Lewis County Emergency Physicians

  • Emergency Medicine Physician
  • Centralia, WA
  • NPI 1174555684
  NPD (past)
• Salem Health West Valley

  • Critical Access Hospital
  • Dallas, OR
  • NPI 1245237486
  NPD (past)
• Salem Radiology Consultants PC

  • Diagnostic Radiology Physician
  • Salem, OR
  • NPI 1649221813
  NPD (past)
• Springfield Emergency Physicians, Inc.

  • Emergency Medicine Physician
  • Springfield, OH
  • NPI 1407810534
  NPD (past)
• West Valley Hospital Pharmacy

  • Community/Retail Pharmacy
  • Dallas, OR
  • NPI 1871829796
  NPD (past)

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525046400000",
    "number": "1881665099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 LIND AVE SW",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980574934",
            "telephone_number": "425-228-3440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10555 SE CARR RD BLDG M",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555820",
            "telephone_number": "425-656-4270",
            "fax_number": "425-656-4271"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13305 NW Cornell Rd Ste C",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972295987",
            "country_code": "US",
            "telephone_number": "503-646-8500",
            "fax_number": "503-646-8200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIN",
        "first_name": "SE JUNG",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-27",
        "last_updated": "2018-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "MD22180",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD00038373",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130308",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "G8959946",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2065309",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Micah M Shimabuku, PT
• Heather Teruko Shimamoto, PHARM.D.
• Teresa Shimizu, PT
• Ally J Shin, ARNP
• Chang B. Shin, M.D.
• Garth Shippen, LO
• Hafsa Shire
• Galina Shkinder
• James Franklin Shockley Jr.
• Beatrice Amir Shokralla

• Emergency Medicine Physician in Renton, WA
• Providers in Renton, WA by specialty
• Emergency Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2018; 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.