Healthcare Provider Details

I. General information

NPI: 1861710717
Provider Name (Legal Business Name): UNJOO ELLEN SHIM PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN UNJOO SHIM PHARM.D.

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 W REDONDO BEACH BLVD
GARDENA CA
90247-3411
US

IV. Provider business mailing address

1208 W REDONDO BEACH BLVD
GARDENA CA
90247-3411
US

V. Phone/Fax

Practice location:
  • Phone: 310-323-4768
  • Fax:
Mailing address:
  • Phone: 310-323-4768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number49076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: