Provider Demographics
NPI:1942524293
Name:YING SHIM, MD PA
Entity Type:Organization
Organization Name:YING SHIM, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-659-3003
Mailing Address - Street 1:3363 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-4225
Mailing Address - Country:US
Mailing Address - Phone:201-659-3003
Mailing Address - Fax:201-659-3594
Practice Address - Street 1:3363 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-4225
Practice Address - Country:US
Practice Address - Phone:201-659-3003
Practice Address - Fax:201-659-3594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA25304305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1D2853302Medicaid
NJC12409Medicare PIN