MEDICARE: SHAN YIN M.D.

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
1	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	35.096028	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36-4187449	OTHER	IL	TAX IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1558316414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAN YIN M.D.

Provider Business Mailing Address
First Line	:	3333 BURNET AVE
Second Line	:	ML 2008
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3039
Country	:	US
Telephone Number	:	513-636-7966
Fax Number	:	513-636-7967

Provider Business Practice Location Address
First Line	:	3333 BURNET AVE
Second Line	:	ML 2008
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3039
Country	:	US
Telephone Number	:	513-636-7966
Fax Number	:	513-636-7967

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	12/27/2010

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Directions to “ SHAN YIN M.D.” Practice Location

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