MEDICARE: UNJOO ELLEN SHIM PHARM.D.

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	1835P1200X	Pharmacotherapy Pharmacist	49076	CA

General Provider Information

NPI Number	:	1861710717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UNJOO ELLEN SHIM PHARM.D.

Provider Business Mailing Address
First Line	:	1208 W REDONDO BEACH BLVD
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-3411
Country	:	US
Telephone Number	:	310-323-4768
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 W REDONDO BEACH BLVD
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-3411
Country	:	US
Telephone Number	:	310-323-4768
Fax Number	:

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

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	05/17/2010

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