Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 22DI02329900 | NJ |
N | 122300000X | Dentist | 9363084 | NY |
Y | 1223P0300X | Periodontist | 057009 | NJ |
NPI | 1104930056 |
---|---|
Provider Name | Eunjung Shim |
First Address | Emerson, NJ 07630-1513 |
Second Address | Bayonne, NJ 07002-3899 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 05/10/2016 |