Healthcare Provider Details

I. General information

NPI: 1265163802
Provider Name (Legal Business Name): JUNSEOK SHIM AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN SHIM

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23822 VALENCIA BLVD STE 103
SANTA CLARITA CA
91355-5303
US

IV. Provider business mailing address

6700 WASHINGTON AVE S
EDEN PRAIRIE MN
55344-3405
US

V. Phone/Fax

Practice location:
  • Phone: 661-253-3277
  • Fax: 661-289-1490
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: