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YEYONGSHIN DO INC
NPI 1215508247
Family Medicine in Diamond Bar, CA

Active since July 09, 2021CLIA 05D2258528 · Waiver
1111 GRAND AVE STE J, DIAMOND BAR, CA 91765(909) 306-4102 Get Directions Write a Review

NPPES record last updated: July 9, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Yeyongshin Do Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

YEYONGSHIN DO INC (NPI 1215508247) is a healthcare organization registered as a family medicine in Diamond Bar, California and active in the NPI registry since July 2021. The organization holds a CLIA Waiver certificate valid through April 21, 2028 and lists Yeyong Shin, Owner, as its authorized official.

NPPES Registry Identity

NPI1215508247
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameYEYONGSHIN DO INC
Location Address1111 GRAND AVE STE JDiamond Bar, CA 91765-4172
Mailing Address1111 Grand Ave Ste JDiamond Bar, CA 91765-4172 · (909) 306-4102
Phone(909) 306-4102
Organization SubpartNo
Authorized OfficialYeyong ShinOwner · (909) 306-4102
Enumeration DateJuly 9, 2021
NPPES CertifiedJuly 9, 2021
✔ NPI 1215508247 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
1111 GRAND AVE STE J, Diamond Bar, CA 91765
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Yeyongshin Do Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Yeyongshin Do Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Yeyong Shin, DO
Family Practice
NPI 1679831028
9655 MONTE VISTA AVE STE 402
Montclair, CA 91763
(909) 626-1205
✔ PECOS✔ Accepts Medicare8.6 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2258528

Yeyongshin Do Inc · Diamond Bar, CA
Active · expires Apr 21, 2028
CLIA Number05D2258528
Laboratory TypePhysician Office
Certificate Effective DateApril 22, 2026
Certificate Expiration DateApril 21, 2028
Laboratory DirectorDr. Yeyong Shin
Laboratory Phone(909) 895-7735
Laboratory LocationYeyongshin Do Inc1111 Grand Avenue, Suite J, Diamond Bar, CA 91765
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Yeyongshin Do Inc's NPI number?

The NPI number for Yeyongshin Do Inc is 1215508247. It was assigned to this organization in the NPPES registry on July 9, 2021.

Where is Yeyongshin Do Inc located?

Yeyongshin Do Inc is located at 1111 Grand Ave Ste J, Diamond Bar, CA 91765. The listed phone number is (909) 306-4102.

What is Yeyongshin Do Inc's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Yeyongshin Do Inc enrolled in Medicare?

Yes. Yeyongshin Do Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Yeyongshin Do Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Yeyongshin Do Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Yeyongshin Do Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2258528) is associated with this NPI, valid through April 21, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Yeyongshin Do Inc was last updated on July 9, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.