DR. BO KYONG SHIN DPM
NPI 1568769149
Podiatrist in Los Angeles, CA
About Dr. Bo Kyong Shin Dpm NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. BO KYONG SHIN DPM (NPI 1568769149) is an individual podiatrist in Los Angeles, California, licensed in New Jersey (25MD00308100) and active in the NPI registry since February 2011. She is enrolled in Medicare PECOS, maintains a secondary practice location in Los Angeles, and is a graduate of Other (2008).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dr. Bo Kyong Shin Dpm is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
2Medicare enrollment records show Bo Shin reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Los Angeles, CA 90027
- Reassigned Medicare billing, California enrollment
- 75 clinicians in this Medicare group
New Hyde Park, NY 11042
- Reassigned Medicare billing, New Jersey enrollment
- 417 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 90029 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
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.
LOS ANGELES, CA 90029
LOS ANGELES, CA 90029
LOS ANGELES, CA 90029
LOS ANGELES, CA 90029
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 Bo Shin's NPI number?
The NPI number for Bo Shin is 1568769149. It was assigned to this individual provider in the NPPES registry on February 17, 2011.
Where is Bo Shin located?
Bo Shin practices at 4618 Fountain Ave, Los Angeles, CA 90029. The listed phone number is (323) 953-7170.
What is Bo Shin's specialty?
The primary specialty registered for this NPI is Podiatrist with taxonomy code 213E00000X.
Is Bo Shin enrolled in Medicare?
Yes. Bo Shin is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Bo Shin's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Bo Shin reassigns Medicare benefits to 2 organizations: Gracelight Community Health (Los Angeles, CA) and Optum Medical Care Of New Jersey PC (New Hyde Park, NY). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Bo Shin's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Bo Shin was last updated on September 28, 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.
# Dr. Bo Kyong Shin, DPM · NPI 1568769149
Podiatrist provider in Los Angeles, California. Individual provider, active in the CMS NPPES registry since February 17, 2011.
## Identity
- **NPI:** 1568769149 (Entity type: Individual)
- **Enumerated:** February 17, 2011
- **Primary specialty:** Podiatrist · taxonomy 213E00000X
- **State license:** 25MD00308100 (New Jersey)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 4618 FOUNTAIN AVE, Los Angeles, CA 90029-1830
- **Phone:** (323) 953-7170 · **Fax:** (323) 663-2379
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Gracelight Community Health (NPI 1639241888, Los Angeles, CA); Optum Medical Care Of New Jersey PC (NPI 1578665048, New Hyde Park, NY) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2008
## Record status
- **NPPES last updated:** September 28, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1568769149) · Data from the CMS NPPES public registry.