DR. JAE Y SHIN (NPI# 1396088803) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396088803 |
| Entity Type | Individual |
| Full Name | DR. JAE Y SHIN |
| Credential | D.P.M. |
| Practice Address |
506 Osigian Blvd Ste 5 Warner Robins GA 31088-8985 |
| Mailing Address |
Po Box 6007 Warner Robins GA 31095-6007 |
| Practice Telephone | 4789884676 |
| Practice Fax Number | 4789877907 |
| Mailing Telephone | 4789290036 |
| Mailing Fax Number | 4789291744 |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2020-07-24 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213EP1101X |
Podiatrist Specialization: Primary Podiatric Medicine |
POD001311 | GA | Podiatric Medicine & Surgery Service Providers |
| N | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
POD001311 | GA | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | PODIATRIC LICENSE | POD001311 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1030 Peach Pkwy Ste 1, Fort Valley, GA 310308191 | 4789884676 | 4789877907 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376661314 | Jae Kuaen Shin | Pharmacist | 3170 W Olympic Blvd Ste D, Los Angeles, CA 90006-2400 | 2007-03-27 |
| 1922468594 | Jae Shin | Pharmacist | 2100 Pfingsten Rd, Glenview, IL 60026-1301 | 2016-02-25 |
| 1578948725 | Jae Shin | Dentist | 7101 Hoff St Bldg 9240, Fort Benning, GA 31905-5645 | 2015-07-29 |
| 1225439367 | Jae Shin | Dentist | 14-20 Macdade Blvd, Collingdale, PA 19023-1821 | 2014-09-09 |
| 1831443803 | Jae Eun Shin | Marriage & Family Therapist | 3727 W 6th St Ste 411, Los Angeles, CA 90020-5112 | 2012-10-30 |
| 1669620142 | Jae Hyun Shin | Internal Medicine | 1300 Jefferson Park Ave, Charlottesville, VA 22903-3363 | 2008-09-08 |
| 1619064326 | Jae Y Shin | Internal Medicine | 3030 N Rocky Point Dr W, Suite 670, Tampa, FL 33607-5906 | 2006-10-06 |
| Street Address |
506 OSIGIAN BLVD STE 5 |
| City | WARNER ROBINS |
| State | GA |
| Zip Code | 31088-8985 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982218921 | Sarah Newman | Pharmacist | 1081 Ga-96, Warner Robins, GA 31088 | 2020-09-08 |
| 1619599115 | Alana Jane Sibley | Registered Nurse | 940 Ga - 96, Warner Robins, GA 31088 | 2020-05-07 |
| 1033779657 | Jodi Lynne Pettygrove | Nurse Practitioner | 115 Havelock Cir, Warner Robins, GA 31088 | 2019-06-17 |
| 1164994901 | Gwendolyn Jordan Taylor | Registered Nurse | 940-c Ga Hwy 96, Same, Warner Robins, GA 31088 | 2018-12-18 |
| 1447721543 | Amy Tanner | Behavioral Analyst | 200 Cresview Church Rd #1806, Warner Robins, GA 31088 | 2018-12-16 |
| 1518435676 | Phoenix Health Center | Case Management | 940 Ga-96, Warner Robins, GA 31088 | 2018-11-07 |
| 1427534320 | Jared Dean Johnson | Social Worker | 146 Lakepointe Drive, Warner Robins, GA 31088 | 2018-07-13 |
| 1285124180 | Cmp Academy & Billing Service | Contractor | 105 S Commercial Circle, Warner Robins, GA 31088 | 2018-05-16 |
| 1730692377 | Benzer Pharmacy | Pharmacy | 150 S Houston Lake Rd Ste 300, Warner Robins, GA 31088 | 2017-11-06 |
| 1821507476 | Timothy Doyle Thomas | Registered Nurse | 940-c Hwy 96, Warner Robins, GA 31088 | 2017-09-27 |
| Find all providers in zip 31088 | ||||
| Taxonomy Code | 213EP1101X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Primary Podiatric Medicine |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942302146 | Dr Osh & Associates PC | Podiatrist | 1043 N Houston Rd, Warner Robins, GA 31093 | 2006-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033741632 | Serenity Podiatry and Med Spa LLC | Podiatrist | 770 Old Roswell Pl Ste A300, Roswell, GA 30076-1697 | 2020-02-11 |
| 1275914749 | Nrup Tolat | Podiatrist | 100 Stoneforest Dr Ste 120, Woodstock, GA 30189 | 2015-06-10 |
| 1598010720 | Swga Foot & Ankle Center | Podiatrist | 415 E 4th Ave Ste B, Cordele, GA 31015-0614 | 2012-07-13 |
| 1548524937 | Swga Foot & Ankle Center | Podiatrist | 922 E Jefferson St Ste D, Americus, GA 31709-4781 | 2012-06-29 |
| 1952667305 | Agape Foot & Ankle Clinic, LLC | Podiatrist | 3693 Wittenburg Ct, Decatur, GA 30034-5507 | 2012-04-10 |
| 1275780199 | Azuka Ifeyinwa Nwaedozie | Podiatrist | 3364 Medina Dr, Jonesboro, GA 30236-6873 | 2008-08-21 |
| 1386804045 | Howard Foot&leg Specialists,pc. | Podiatrist | 12476 Hopewell Rd, Alpharetta, GA 30004-1347 | 2008-06-16 |
| 1053506162 | Diabetic Foot Care Specialist of Georgia | Podiatrist | 238 Walker St Sw, Unit #12, Atlanta, GA 30313-1266 | 2007-09-11 |
| 1356549141 | Dwayne Lay | Podiatrist | 210 Oakside Ln Ste B, Canton, GA 30114-6417 | 2007-07-03 |
| 1710002241 | Personal Foot & Ankle Specialist,pc | Podiatrist | 1820 N Columbia St, Milledgeville, GA 31061-2300 | 2007-03-21 |
| Find all providers with the same taxonomy | ||||
| City | WARNER ROBINS |
| Zip Code | 31088 |
Please comment or provide details below to improve the information on DR. JAE Y SHIN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.