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NPI Code Detail

MEDICARE: MR. YONGDEOK BRUCE SHIN DO

MEDICARE: MR. YONGDEOK BRUCE SHIN DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207R00000XInternal Medicine Physician0102209167VA

General Provider Information

NPI Number : 1033812722
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. YONGDEOK BRUCE SHIN DO
Provider Business Mailing Address
First Line : 213 S JEFFERSON ST STE 1006
Second Line :
City : ROANOKE
State : VA
Zip : 24011-1713
Country : US
Telephone Number : 540-224-5516
Fax Number :
Provider Business Practice Location Address
First Line : 1906 BELLEVIEW AVE SE
Second Line :
City : ROANOKE
State : VA
Zip : 24014-1838
Country : US
Telephone Number : 540-981-7000
Fax Number : 540-853-0931
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2023
Last Update Date : 05/19/2026

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Directions to “ MR. YONGDEOK BRUCE SHIN DO” Practice Location

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