Jong T Shin, DO
Individual provider Active NPI Sports Medicine (Family Medicine) Physician · Cherry Hill, NJ
NPI 1992966717 · NPPES record last updated Aug 13, 2020
Key facts
- NPI
- 1992966717
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Sports Medicine (Family Medicine) Physician 207QS0010X
- License
- 25MB08427400 (NJ)
- Practice address
- 951 Haddonfield Rd # 3B
Cherry Hill, NJ 08002-2783 - Phone
- (856) 270-6800
- Fax
- (856) 324-5958
- NPI assigned
- Jun 24, 2008
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150422001730 | NJ | Order and Referring Only - Family Practice |
7810064730 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS013428 | PA | MD | Family Medicine Physician |
| 25MB08427400 | NJ | MD | Sports Medicine (Family Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Myung Kyu Chung | Family Medicine | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS013428 | PA | |
| Sports Medicine (Family Medicine) Physician | 207QS0010X | OS013428 | PA | |
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 25MB08427400 | NJ | Yes |
Addresses
Primary practice location
951 Haddonfield Rd # 3B
Cherry Hill, NJ 08002-2783
Mailing address
951 Haddonfield Rd BLDG A13
Cherry Hill, NJ 08002-2783
Phone (856) 270-6800
Other providers in Cherry Hill, NJ
- Wade D Shiley
- Marlena Shilman
- Nicole Soojin Shim
- Serena Shim
- Betty S Shimberg
- Jennifer Shiner
- Punitha Shivaprasad
- Shlomo Levy, PSYD LLC
- Hinda Shmidman
- Jusiyah Shoats
All providers in Cherry Hill, NJ · Sports Medicine (Family Medicine) Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.