Provider Demographics
NPI:1518013689
Name:SHIM, ELISABETH K (MD)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:K
Last Name:SHIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1301 20TH ST
Mailing Address - Street 2:SUITE 570
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-315-0171
Mailing Address - Fax:310-828-6647
Practice Address - Street 1:1301 20TH ST
Practice Address - Street 2:SUITE 570
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-315-0171
Practice Address - Fax:310-828-6647
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA65723207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA65723OtherLICENCE
H02879Medicare UPIN
CAWA65723BMedicare ID - Type Unspecified
CAWA65723AMedicare ID - Type Unspecified