Provider Demographics
NPI:1003453994
Name:SHIM, LYNN JANG
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:JANG
Last Name:SHIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LINCOLN CT
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4608
Mailing Address - Country:US
Mailing Address - Phone:714-422-9922
Mailing Address - Fax:
Practice Address - Street 1:25 LINCOLN CT
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4608
Practice Address - Country:US
Practice Address - Phone:714-422-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137610106H00000X
CA123079106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist