Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | P9959 | TX |
N | 2080P0204X | Pediatric Emergency Doctor | P9959 | TX |
NPI | 1316236052 |
---|---|
Provider Name | Young H Shim |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76104-2733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2011 |
Last Update Date | 19/04/2021 |