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DR. GRACE EUN HAE SHIN DO
NPI 1124714928
Student in an Organized Health Care Education/Training Program in Hackensack, NJ

Active since April 13, 2023PECOS Enrolled
30 PROSPECT AVE, HACKENSACK, NJ 07601(551) 996-9500 Get Directions Write a Review

NPPES record last updated: April 13, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Grace Eun Hae Shin Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. GRACE EUN HAE SHIN DO (NPI 1124714928) is an individual student in an organized health care education/training program in Hackensack, New Jersey, licensed in California (D8797893) and active in the NPI registry since April 2023. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1124714928
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameDR. GRACE EUN HAE SHINCredential: DO
Location Address30 PROSPECT AVEHackensack, NJ 07601-1915
Mailing Address30 Prospect AveHackensack, NJ 07601-1915
Phone(551) 996-9500
Sole ProprietorYes
Enumeration DateApril 13, 2023
NPPES CertifiedApril 13, 2023
✔ NPI 1124714928 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
License✔ Licensed in CA · D8797893
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
30 PROSPECT AVE, Hackensack, NJ 07601
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Grace Eun Hae Shin Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JESUS RAFAEL ALVAREZ-PEREZ M.D.
Obstetrics & Gynecology (Maternal & Fetal Medicine)
30 PROSPECT AVE
HACKENSACK, NJ 07601
Bergen County (551) 996-2453
JENNIFER NORTHRIDGE M.D.
Pediatrics (Adolescent Medicine)
30 PROSPECT AVE
HACKENSACK, NJ 07601
Bergen County (551) 996-2237
ANALYSA GALLEGOS MD
Emergency Medicine
30 PROSPECT AVE
HACKENSACK, NJ 07601
Bergen County (551) 996-2331
DR. PAARTH RAJ D.O.
Emergency Medicine
30 PROSPECT AVE
HACKENSACK, NJ 07601
Bergen County (201) 996-2000
MRS. LAUREN ANNE CARUCCI NP-C
Nurse Practitioner (Adult Health)
30 PROSPECT AVE
HACKENSACK, NJ 07601
Bergen County (551) 996-2000
MS. SOMDATTA GUPTA
Anesthesiology
30 PROSPECT AVE
HACKENSACK, NJ 07601
Bergen County (973) 216-7796
JOSE DESCHAMPS
Emergency Medicine
30 PROSPECT AVE
HACKENSACK, NJ 07601
Bergen County (551) 996-2000
ALEXANDER SHERMAN DO
Anesthesiology
30 PROSPECT AVE
HACKENSACK, NJ 07601
Bergen County (818) 635-2802

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Grace Shin's NPI number?

The NPI number for Grace Shin is 1124714928. It was assigned to this individual provider in the NPPES registry on April 13, 2023.

Where is Grace Shin located?

Grace Shin practices at 30 Prospect Ave, Hackensack, NJ 07601. The listed phone number is (551) 996-9500.

What is Grace Shin's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Grace Shin enrolled in Medicare?

Yes. Grace Shin is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Grace Shin was last updated on April 13, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.