Provider Demographics
NPI:1942377726
Name:SHIM, SUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUNG
Middle Name:
Last Name:SHIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:SHIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMS
Mailing Address - Street 1:3020 HIGHLANDS PKWY SE
Mailing Address - Street 2:STE. A
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-5125
Mailing Address - Country:US
Mailing Address - Phone:770-319-9113
Mailing Address - Fax:770-319-9813
Practice Address - Street 1:3020 HIGHLANDS PKWY SE
Practice Address - Street 2:STE. A
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5125
Practice Address - Country:US
Practice Address - Phone:770-319-9113
Practice Address - Fax:770-319-9813
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0126071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice