Provider Demographics
NPI:1386145373
Name:JOCELYN Y. SHIN D.D.S., LLC
Entity type:Organization
Organization Name:JOCELYN Y. SHIN D.D.S., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-824-3360
Mailing Address - Street 1:825 SAINT MARKS WALK
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1288
Mailing Address - Country:US
Mailing Address - Phone:443-824-3360
Mailing Address - Fax:
Practice Address - Street 1:106 OLD PADONIA RD
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-4968
Practice Address - Country:US
Practice Address - Phone:410-628-0118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-24
Last Update Date:2018-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD152961223G0001X
GADN0142171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADN014217OtherGEORGIA BOARD OF DENTISTRY