Provider Demographics
NPI:1508036781
Name:ELAINE T. SHIM, DDS, PC
Entity Type:Organization
Organization Name:ELAINE T. SHIM, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-567-1887
Mailing Address - Street 1:1550 N GREEN VALLEY PKWY
Mailing Address - Street 2:#350
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7108
Mailing Address - Country:US
Mailing Address - Phone:702-567-1887
Mailing Address - Fax:
Practice Address - Street 1:1550 N GREEN VALLEY PKWY
Practice Address - Street 2:#350
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7108
Practice Address - Country:US
Practice Address - Phone:702-567-1887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3525261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center