Provider Demographics
NPI:1386075851
Name:SHIN, HOJUN (LAC)
Entity type:Individual
Prefix:
First Name:HOJUN
Middle Name:
Last Name:SHIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5132 EDON HALL LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6217
Mailing Address - Country:US
Mailing Address - Phone:757-513-3910
Mailing Address - Fax:757-317-0265
Practice Address - Street 1:5295 GREENWICH RD STE 104
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6046
Practice Address - Country:US
Practice Address - Phone:757-513-3910
Practice Address - Fax:757-317-0265
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0121000841171100000X
CAAC15349171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist