Provider Demographics
NPI:1588624043
Name:SHIM, JAIMOON MARCUS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIMOON
Middle Name:MARCUS
Last Name:SHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-2617
Mailing Address - Country:US
Mailing Address - Phone:804-541-3024
Mailing Address - Fax:804-452-2176
Practice Address - Street 1:406 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2617
Practice Address - Country:US
Practice Address - Phone:804-541-3024
Practice Address - Fax:804-452-2176
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032780174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC03320Medicare PIN
VAC03221Medicare PIN