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General NPI Number Information
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NPI Number | 1811212160
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Entity Type | Organization
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Legal Business Name | KEE D SHIN, M.D., S.C
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Dates
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Enumeration Date | 03/30/2010
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 3825 HIGHLAND AVE SUITE 3D
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1552
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Country | US
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Telephone | 630-964-7006
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Fax |
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Provider Business Mailing Address
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Address Line | 3825 HIGHLAND AVE SUITE 3D
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1552
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Country | US
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Telephone | 630-964-7006
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. KEE D SHIN
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Credential |
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Telephone | 630-964-7006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036052151
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License Number State | IL
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