# BRYAN SHIN, DDS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487385175
- **Authorized official:** BRYAN IKSU SHIN DDS (DENTIST)
- **Authorized official phone:** (614) 364-1695

## Contact information

- **Practice address:** 25052 104TH AVE SE STE E, KENT, WA 98030-6853
- **Practice address phone:** (253) 236-0384
- **Mailing address:** 12721 192ND PL E, BONNEY LAKE, WA 98391-8362
- **Mailing address phone:** (614) 364-1695

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 06/22/2022
- **Last updated:** 06/22/2022