MEDICARE: DR. JOHN Y SHIM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	MA25304	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538236187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN Y SHIM MD

Provider Business Mailing Address
First Line	:	3363 KENNEDY BOULEVARD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307
Country	:	US
Telephone Number	:	201-659-3003
Fax Number	:	201-659-3594

Provider Business Practice Location Address
First Line	:	3363 KENNEDY BOULEVARD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307
Country	:	US
Telephone Number	:	201-659-3003
Fax Number	:	201-659-3594

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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