Provider Demographics
NPI:1609593813
Name:SOON Y. SHIM DDS, INC
Entity Type:Organization
Organization Name:SOON Y. SHIM DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:YONG
Authorized Official - Last Name:SHIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-522-4445
Mailing Address - Street 1:7540 ORANGETHORPE AVE STE C4
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3458
Mailing Address - Country:US
Mailing Address - Phone:714-522-4445
Mailing Address - Fax:
Practice Address - Street 1:7540 ORANGETHORPE AVE STE C4
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3458
Practice Address - Country:US
Practice Address - Phone:714-522-4445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental