Healthcare Provider Details

I. General information

NPI: 1588679088
Provider Name (Legal Business Name): YONG-BING SHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

18791 SW WHITE OAK LN
BEAVERTON OR
97007-4542
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-5674
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD24611
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: