NPIMap

Individual provider Active NPI

Yong Ki Shin, M.D.

  • Internal Medicine Physician
  • Montesano, WA
National Provider Identifier
1851364988
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD00032900 Issued in WA
Practice address
112 E Broadway Ave
Montesano, WA 98563-3704
Phone
(360) 249-4111
Fax
(360) 249-5220
NPI assigned
Feb 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD00032900 WA Primary

Addresses

Primary practice location

112 E Broadway Ave
Montesano, WA 98563-3704

Mailing address

112 E Broadway Ave
Montesano, WA 98563-3704
Phone (360) 249-4111

Other identifiers 1

IdentifierTypeStateIssuer
1101344MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070228000674 WA Practitioner - Internal Medicine 2769372697 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Washington School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

112 E Broadway Ave
Montesano, WA 98563-3704
Phone (360) 249-4111

3920 Capital Mall Dr SW
Suite 200
Olympia, WA 98502-8701
Phone (360) 459-7282

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions62
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD00032900WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Capital Medical Center Physicians LLC CurrentSince Apr 1, 2024 Accepting new patients
Public Hospital District No 1 of Mason County Wa CurrentSince Mar 10, 2006 Accepting new patients
Montesano Internal Medicine, PS Internal Medicine CurrentSince Jul 1, 1997 Accepting new patients
Public Hospital District No 1 of Mason County CurrentSince Mar 10, 2006 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Sep 12, 2017 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Sep 12, 2017 Accepting new patients
Kaiser Foundation Health Plan of Washington Current Accepting new patients
Capital Medical Center Physicians LLC Internal Medicine CurrentSince Apr 1, 2024 Accepting new patients
Capital Medical Center Physicians LLC Past Accepting new patients

Locations

600 E Main St
Elma, WA 98541
Phone (360) 346-2222

112 E Broadway Ave
Montesano, WA 98563
Phone (360) 249-4111

700 Lilly Rd NE
Olympia, WA 98506
Phone (360) 923-7000

3920 Capital Mall Dr SW
Ste 200
Olympia, WA 98502
Phone (360) 459-7282

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

901 Mountain View Dr
Shelton, WA 98584
Phone (360) 426-1611

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Interoperability endpoints

  • Direct secure messaging: yshin001@direct.sp-mc.org
  • Direct secure messaging: kshinmd6007@direct.multicare.org

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1851364988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 E BROADWAY AVE",
            "city": "MONTESANO",
            "state": "WA",
            "postal_code": "985633704",
            "telephone_number": "360-249-4111",
            "fax_number": "360-249-5220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 E BROADWAY AVE",
            "city": "MONTESANO",
            "state": "WA",
            "postal_code": "985633704",
            "telephone_number": "360-249-4111",
            "fax_number": "360-249-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIN",
        "first_name": "YONG",
        "middle_name": "KI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00032900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1101344",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montesano, WA

Sources for this page

Verify at the official NPI Registry.