Provider Demographics
NPI:1093779373
Name:YEN, SHING I (MD)
Entity Type:Individual
Prefix:
First Name:SHING
Middle Name:I
Last Name:YEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2426
Mailing Address - Country:US
Mailing Address - Phone:708-388-5500
Mailing Address - Fax:
Practice Address - Street 1:2320 HIGH ST
Practice Address - Street 2:RETIRED 12-31-2014
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2426
Practice Address - Country:US
Practice Address - Phone:708-388-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046660207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12512Medicare UPIN
IL200029545Medicare PIN
IL036046660Medicaid
IL200029545OtherRAILROAD MEDICARE
IL468970Medicare PIN