Provider Demographics
NPI:1982433892
Name:SHINO, MIRNA (DDS)
Entity type:Individual
Prefix:
First Name:MIRNA
Middle Name:
Last Name:SHINO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 E SAN FERNANDO ST UNIT 1501
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95113-2545
Mailing Address - Country:US
Mailing Address - Phone:209-485-6852
Mailing Address - Fax:
Practice Address - Street 1:5278 MONTEREY HWY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-4268
Practice Address - Country:US
Practice Address - Phone:408-362-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1103591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice