Healthcare Provider Details

I. General information

NPI: 1417574062
Provider Name (Legal Business Name): BOB YEON SHIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E ST NW L209
WASHINGTON DC
20520-5712
US

IV. Provider business mailing address

4328 N BERNARD ST
CHICAGO IL
60618-1110
US

V. Phone/Fax

Practice location:
  • Phone: 202-663-1779
  • Fax:
Mailing address:
  • Phone: 630-779-5029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD500001787
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036089183
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: