Healthcare Provider Details

I. General information

NPI: 1487393674
Provider Name (Legal Business Name): YUSHENG DONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 W 10TH ST STE C
METROPOLIS IL
62960-2482
US

IV. Provider business mailing address

1204 W 10TH ST STE C
METROPOLIS IL
62960-2482
US

V. Phone/Fax

Practice location:
  • Phone: 618-524-2182
  • Fax: 618-524-2451
Mailing address:
  • Phone: 618-524-2176
  • Fax: 618-524-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13753
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: