Provider Demographics
NPI:1992383905
Name:SHIN, DANIEL HEAN
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:HEAN
Last Name:SHIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 W BRAMBLETON AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1005
Mailing Address - Country:US
Mailing Address - Phone:757-446-5910
Mailing Address - Fax:757-625-0466
Practice Address - Street 1:855 W BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1005
Practice Address - Country:US
Practice Address - Phone:757-446-5910
Practice Address - Fax:757-625-0466
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program