Provider Demographics
NPI:1194914515
Name:SHIN, REBECCA HEA-SUN (DMD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:HEA-SUN
Last Name:SHIN
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 JEFFERSON HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-8502
Mailing Address - Country:US
Mailing Address - Phone:540-943-8545
Mailing Address - Fax:
Practice Address - Street 1:2542 JEFFERSON HWY STE 104
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-8502
Practice Address - Country:US
Practice Address - Phone:540-943-8545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD90311223D0001X
VA04014126911223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR023197Medicaid