Provider Demographics
NPI:1962585935
Name:SHIN, HOCHUL (DDS)
Entity type:Individual
Prefix:DR
First Name:HOCHUL
Middle Name:
Last Name:SHIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:HO
Other - Last Name:SHIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:22 AVE AT PORT IMPERIAL APT 522
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-7807
Mailing Address - Country:US
Mailing Address - Phone:201-865-0088
Mailing Address - Fax:
Practice Address - Street 1:660 KINDERKAMACK RD STE 202
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1525
Practice Address - Country:US
Practice Address - Phone:201-634-9400
Practice Address - Fax:201-634-9488
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI021559001223P0300X
NY0487421223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics