Individual provider Active NPI

Daniel Shin

  • Physical Therapist
  • Arlington, VA
National Provider Identifier
1972163616
Registry record updated Jun 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305212230 Issued in VA
Practice address
1785 S Hayes St
Arlington, VA 22202-2714
Phone
(703) 920-5700
NPI assigned
Jun 15, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305212230 VA Primary

Addresses

Primary practice location

1785 S Hayes St
Arlington, VA 22202-2714

Mailing address

4316 6TH St S
Arlington, VA 22204-1412
Phone (919) 260-4103

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211102001567 CA Practitioner - Physical Therapist in Private Practice 1456682566 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2305212230VAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
New Life Physical Therapy Services, PC Physical Therapist CurrentSince Sep 28, 2021 Accepting new patients
Qarmon PC Past Accepting new patients

Locations

17122 Beach Blvd
Ste 101
Huntington Beach, CA 92647
Phone (714) 848-7191

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1560556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560556800000",
    "number": "1972163616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4316 6TH ST S",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222041412",
            "telephone_number": "919-260-4103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1785 S HAYES ST",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222022714",
            "telephone_number": "703-920-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIN",
        "first_name": "DANIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-15",
        "last_updated": "2019-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305212230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.