| Doctor Name: | DR. JACOB SHIN |
| NPI Number: | 1003221763 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 125.066877 |
| Business Practice Address: | 330 Mount Auburn St Cambridge, MA - 021385502 |
| Business Phone Number: | 6174995160 |
| Business Fax Number: | |
| Mailing Address: | 1650 W Harrison St, Ste 466 CHICAGO |
| State: | IL |
| Postal Code: | 606123800 |
| Phone Number: | 3129425751 |
| Fax Number: | |
| NPI Enumeration Date: | 06/21/2014 |
| NPI Last Update Date: | 06/05/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0203X |
| License Number: | 125.066877 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Therapeutic Radiology |
| Taxonomy Definition: | |