Provider Demographics
NPI:1336371426
Name:SHIN, DONGHI (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:DONGHI
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4260 CENTRAL RD APT 301
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-5617
Mailing Address - Country:US
Mailing Address - Phone:847-894-0522
Mailing Address - Fax:
Practice Address - Street 1:523 S BARTLETT RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-1309
Practice Address - Country:US
Practice Address - Phone:630-372-7372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000570171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist