Provider Demographics
NPI:1881623338
Name:SHIN, YONG SHIK (MD)
Entity type:Individual
Prefix:
First Name:YONG
Middle Name:SHIK
Last Name:SHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:YONG
Other - Middle Name:SHIK
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:600 CREEKSIDE DR
Mailing Address - Street 2:STE 609
Mailing Address - City:SANATOGA
Mailing Address - State:PA
Mailing Address - Zip Code:19464
Mailing Address - Country:US
Mailing Address - Phone:610-327-1631
Mailing Address - Fax:610-327-1199
Practice Address - Street 1:1630 E HIGH ST BLDG 4
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464
Practice Address - Country:US
Practice Address - Phone:610-327-1631
Practice Address - Fax:610-327-1199
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034368L2084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0545215Medicaid
155660Medicare ID - Type Unspecified
PA0545215Medicaid