Healthcare Provider Details

I. General information

NPI: 1932025566
Provider Name (Legal Business Name): SANDRA SHIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 E ALONDRA BLVD
COMPTON CA
90221-4402
US

IV. Provider business mailing address

3701 OVERLAND AVE APT C129
LOS ANGELES CA
90034-6347
US

V. Phone/Fax

Practice location:
  • Phone: 424-785-6995
  • Fax:
Mailing address:
  • Phone: 669-268-4086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: