Provider Demographics
NPI:1265163802
Name:SHIM, JUNSEOK (AUD)
Entity type:Individual
Prefix:
First Name:JUNSEOK
Middle Name:
Last Name:SHIM
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:SHIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6700 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23822 VALENCIA BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-5303
Practice Address - Country:US
Practice Address - Phone:661-253-3277
Practice Address - Fax:661-289-1490
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237700000X, 231H00000X
CA3704231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist