Provider Demographics
NPI:1851364988
Name:SHIN, YONG KI (MD)
Entity Type:Individual
Prefix:
First Name:YONG
Middle Name:KI
Last Name:SHIN
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 1:112 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
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1101344Medicaid
WA1101344Medicaid
G48576Medicare UPIN