Provider Demographics
NPI:1225333651
Name:SHIM, JAE H (MD)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:H
Last Name:SHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2800 S SEACREST BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7960
Mailing Address - Country:US
Mailing Address - Phone:561-740-2004
Mailing Address - Fax:561-742-8226
Practice Address - Street 1:2800 S SEACREST BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7960
Practice Address - Country:US
Practice Address - Phone:561-740-2004
Practice Address - Fax:561-742-8226
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-15
Last Update Date:2011-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAP2447171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist