Individual
BONGYEON SHIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
192 W ROLLINS RD, ROUND LAKE BEACH, IL 60073-1324
(847) 201-4706
(847) 201-8707
Mailing address
600 OAKMONT LN STE 600C, WESTMONT, IL 60559-5548
(630) 575-6200
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070021571
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL8878
MEDICARE PTAN
IL
Enumeration date
02/15/2016
Last updated
12/19/2018
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