Individual
KEE DONG SHIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3825 HIGHLAND AVE, 3D, DOWNERS GROVE, IL 60515-1552
(630) 964-7006
(630) 964-7082
Mailing address
3825 HIGHLAND AVE, 3D, DOWNERS GROVE, IL 60515-1552
(630) 964-7006
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-052151
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002201217
BLUECROSS
IL
05
—
036052151
—
IL
01
—
363142614
FEDERAL TAX ID
IL
Enumeration date
09/01/2006
Last updated
06/20/2019
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