Provider Demographics
NPI:1073683314
Name:MONTESANO INTERNAL MEDICINE, PS
Entity Type:Organization
Organization Name:MONTESANO INTERNAL MEDICINE, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YONG
Authorized Official - Middle Name:KI
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-249-4111
Mailing Address - Street 1:112 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-3704
Mailing Address - Country:US
Mailing Address - Phone:360-249-4111
Mailing Address - Fax:360-249-5220
Practice Address - Street 1:112 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-3704
Practice Address - Country:US
Practice Address - Phone:360-249-4111
Practice Address - Fax:360-249-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty