Healthcare Provider Details

I. General information

NPI: 1407814130
Provider Name (Legal Business Name): SIMON J SHIM PHD, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S DOBSON RD SUITE D-34
CHANDLER AZ
85224-5678
US

IV. Provider business mailing address

600 S DOBSON RD SUITE D-34
CHANDLER AZ
85224-5678
US

V. Phone/Fax

Practice location:
  • Phone: 480-821-6020
  • Fax: 480-821-6022
Mailing address:
  • Phone: 480-821-6020
  • Fax: 480-821-6022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0386
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: