Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 10131 | TX |
NPI | 1518040963 |
---|---|
Provider Name | Choong Shim |
First Address | Lewisville, TX 75067-4111 |
Second Address | Lewisville, TX 75067-4111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2006 |
Last Update Date | 08/07/2007 |