Provider Demographics
NPI:1811212160
Name:KEE D SHIN, M.D., S.C
Entity Type:Organization
Organization Name:KEE D SHIN, M.D., S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-964-7006
Mailing Address - Street 1:3825 HIGHLAND AVE
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1552
Mailing Address - Country:US
Mailing Address - Phone:630-964-7006
Mailing Address - Fax:
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:SUITE 3D
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-964-7006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052151174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052151Medicaid
IL036052151Medicaid
IL615990Medicare PIN