Provider Demographics
NPI:1821027376
Name:YONG SHIK SHIN MD AND ASSOCIATES LLC
Entity Type:Organization
Organization Name:YONG SHIK SHIN MD AND ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YONG
Authorized Official - Middle Name:SHIK
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-327-1631
Mailing Address - Street 1:1630 E HIGH ST
Mailing Address - Street 2:BLDG #4
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3244
Mailing Address - Country:US
Mailing Address - Phone:610-327-1631
Mailing Address - Fax:610-327-1199
Practice Address - Street 1:1630 E HIGH ST
Practice Address - Street 2:BLDG #4
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3244
Practice Address - Country:US
Practice Address - Phone:610-327-1631
Practice Address - Fax:610-327-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA092241UC6Medicare ID - Type UnspecifiedMONTGOMERY COUNTY
PA092437UDTMedicare ID - Type UnspecifiedBERKS COUNTY