MONTESANO INTERNAL MEDICINE, P.S.

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Company Details

Legal Name:	MONTESANO INTERNAL MEDICINE, P.S.
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL SERVICE CORPORATION
Category:	DOMESTIC ENTITY
Status:	Active
Formation/ Registration Date:	April 5th 2010
Expiration date:	30 Apr 2026
UBI Number:	603 006 937
ZIP code:	98563
City:	Montesano
County:	GRAYS HARBOR
Home State:	WASHINGTON
Principal Office Street Address:	112 E BROADWAY AVE, MONTESANO, WA, 98563-3704, UNITED STATES
Principal Office Mailing Address:	101 FIRST STREET SOUTH, MONTESANO, WA, 98563, UNITED STATES
Supporting healthcare providers fighting with COVID-19:	$36,084

Contact Details

E-Mail:	CHANDRA.MONTEIM@GMAIL.COM
Phone Number:	+1 360-249-4111

Nature of Business

INTERNAL MEDICINE PRACTICE

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Registered Agent Information

Name	Role	Address
WILLIAM J. STEWART	Registered Agent	101 S 1ST ST, MONTESANO, WA, 98563-3601, UNITED STATES

Key Officers & Management

Name	Role	Address
Y. KI SHIN, M.D.	Governing Person	112 BROADWAY E, MONTESANO, WA, 98563, UNITED STATES
CLARA C. SHIN, M.D.	Governing Person	112 BROADWAY E, MONTESANO, WA, 98563, UNITED STATES

National Provider Identifier

NPI Number:

1073683314

Certification Date:

2024-04-03

Link:

View on NPI website

Authorized Person:

Name:

YONG KI SHIN

Role:

PRESIDENT AND CO-OWNER

Phone:

3602494111

Taxonomy:

Selected Taxonomy:

207R00000X - Internal Medicine Physician

Is Primary:

Yes

Contacts:

Phone:

+1 360-249-4111

Fax:

3602495220

Form 5500 Series

Employer Identification Number (EIN):

911819097

Plan Year:

2023

Number Of Participants:

9

Plan Name:

401(K)

Sponsor's telephone number:

3602494111

File:

Plan Year:

2022

Number Of Participants:

10

Plan Name:

401(K)

Sponsor's telephone number:

3602494111

File:

Plan Year:

2021

Number Of Participants:

11

Plan Name:

401(K)

Sponsor's telephone number:

3602494111

File:

Plan Year:

2020

Number Of Participants:

11

Plan Name:

401(K)

Sponsor's telephone number:

3602494111

File:

Plan Year:

2019

Number Of Participants:

15

Plan Name:

401(K)

Sponsor's telephone number:

3602494111

File:

Paycheck Protection Program

Jobs Reported:

6

Initial Approval Amount:

$72,500

Date Approved:

2020-04-15

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$72,500

Race:

Unanswered

Ethnicity:

Unknown/NotStated

Gender:

Female Owned

Veteran:

Non-Veteran

Forgiveness Amount:

$73,344.18

Servicing Lender:

Umpqua Bank

Use of Proceeds:

Payroll: $72,500

Jobs Reported:

6

Initial Approval Amount:

$68,125

Date Approved:

2021-02-05

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$68,125

Race:

Unanswered

Ethnicity:

Unknown/NotStated

Gender:

Unanswered

Veteran:

Unanswered

Forgiveness Amount:

$68,371.37

Servicing Lender:

Umpqua Bank

Use of Proceeds:

Payroll: $68,124

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