Provider Demographics
NPI:1174859326
Name:SHIM, YOON KYUNG (LAC)
Entity Type:Individual
Prefix:
First Name:YOON KYUNG
Middle Name:
Last Name:SHIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 NOBLE RD
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2314
Mailing Address - Country:US
Mailing Address - Phone:267-307-3114
Mailing Address - Fax:
Practice Address - Street 1:8033 OLD YORK RD STE 203A
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1422
Practice Address - Country:US
Practice Address - Phone:267-307-3114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13390171100000X
PAOM000096171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty