Provider Demographics
NPI:1023130630
Name:SHEEN, YOUNGKYU PETER (MD)
Entity type:Individual
Prefix:MR
First Name:YOUNGKYU
Middle Name:PETER
Last Name:SHEEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:Y
Other - Middle Name:PETER
Other - Last Name:SHEEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5138 SEA MIST COURT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4227
Mailing Address - Country:US
Mailing Address - Phone:858-642-0536
Mailing Address - Fax:858-642-0536
Practice Address - Street 1:5138 SEA MIST COURT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4227
Practice Address - Country:US
Practice Address - Phone:858-642-0536
Practice Address - Fax:858-642-0536
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37644208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0186589Medicaid
OH0186589Medicaid
C00950Medicare UPIN