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General NPI Number Information
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NPI Number | 1679831028
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Entity Type | Individual
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Provider Name | YEYONG SHIN DO
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Gender | Female
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 10/13/2017
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Provider Practice Location Address
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Address Line | 9655 MONTE VISTA AVE STE 402
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City | MONTCLAIR
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State | CA
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Zip | 91763-2238
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Country | US
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Telephone | 909-626-1205
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Fax | 909-670-0473
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Provider Business Mailing Address
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Address Line | 9655 MONTE VISTA AVE STE. 402
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City | MONTCLAIR
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State | CA
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Zip | 91763-2238
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Country | US
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Telephone | 909-626-1205
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Fax | 909-670-0473
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 20A13107
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A13107
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License Number State | CA
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