Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 036123702 | IL |
Y | 208200000X | Surgeon | 036.123702 | IL |
Y | 208600000X | Surgeon | 036.123702 | IL |
NPI | 1790913093 |
---|---|
Provider Name | Dr. Inbo Shim |
First Address | River Forest, IL 60305-2038 |
Second Address | Chicago, IL 60637-1447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2009 |
Last Update Date | 24/08/2009 |