Organization
JAE YOON SHIN DPM P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAE YOON SHIN DPM (OWNER)
(267) 269-7127
Entity
Organization
Contact information
Practice address
283 LEONARD PL, PARAMUS, NJ 07652-4517
(267) 269-7127
Mailing address
4220 27TH ST APT 515, LONG ISLAND CITY, NY 11101-8618
(267) 268-7127
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MD00365800
PODIATRIC LICENSE
NJ
01
—
N007210-01
PODIATRIC LICENSE
NY
01
—
POD001311
PODIATRIC LICENSE
GA
Enumeration date
02/01/2022
Last updated
02/01/2022
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