| Yeyongshin DO Inc | |
|
1111 Grand Ave Ste J Diamond Bar CA 91765-4172 | |
| (909) 306-4102 | |
| Not Available |
| Full Name | Yeyongshin DO Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1111 Grand Ave Ste J, Diamond Bar, California |
| Authorized Official Name and Position | Yeyong Shin (OWNER) |
| Authorized Official Contact | 9093064102 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Yeyongshin DO Inc 1111 Grand Ave Ste J Diamond Bar CA 91765-4172 Ph: (909) 306-4102 | Yeyongshin DO Inc 1111 Grand Ave Ste J Diamond Bar CA 91765-4172 Ph: (909) 306-4102 |
| NPI Number | 1215508247 |
|---|---|
| Provider Enumeration Date | 07/09/2021 |
| Last Update Date | 07/09/2021 |
| Certification Date | 07/09/2021 |
| Medicare PECOS PAC ID | 5799183877 |
|---|---|
| Medicare Enrollment ID | O20211004001220 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215508247 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Yeyong Shin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679831028 PECOS PAC ID: 3375780216 Enrollment ID: I20150812009237 |
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