Provider Demographics
NPI:1952088650
Name:SHIM, MYUNG SEOK
Entity Type:Individual
Prefix:
First Name:MYUNG SEOK
Middle Name:
Last Name:SHIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 DOUGLASTON PKWY APT 3J
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1872
Mailing Address - Country:US
Mailing Address - Phone:347-339-5126
Mailing Address - Fax:
Practice Address - Street 1:4430 DOUGLASTON PKWY APT 3J
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11363-1872
Practice Address - Country:US
Practice Address - Phone:347-339-5126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308520363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner