Provider Demographics
NPI:1679831028
Name:SHIN, YEYONG (DO)
Entity Type:Individual
Prefix:
First Name:YEYONG
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9655 MONTE VISTA AVE
Mailing Address - Street 2:STE. 402
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2238
Mailing Address - Country:US
Mailing Address - Phone:909-626-1205
Mailing Address - Fax:909-670-0473
Practice Address - Street 1:9655 MONTE VISTA AVE STE 402
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2238
Practice Address - Country:US
Practice Address - Phone:909-626-1205
Practice Address - Fax:909-670-0473
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13107208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist