Healthcare Provider Details

I. General information

NPI: 1306932959
Provider Name (Legal Business Name): WILLIAM JUNGHO SHIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W DR MARTIN LUTHER KING JR BLVD STE 530
TAMPA FL
33607-6000
US

IV. Provider business mailing address

12513 BRIDGETON DRIVE
POTOMAC MD
20854
US

V. Phone/Fax

Practice location:
  • Phone: 240-631-1036
  • Fax: 561-658-6142
Mailing address:
  • Phone: 240-631-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0053771
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME139857
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: