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General NPI Number Information
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NPI Number | 1124335856
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Entity Type | Individual
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Provider Name | DAVID JUNG SUG SHIM PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 1507 WASHINGTON ST
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City | WEST NEWTON
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State | MA
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Zip | 02465-2219
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Country | US
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Telephone | 781-985-5745
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Fax |
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Provider Business Mailing Address
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Address Line | 11 BEAVER ST
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City | WALTHAM
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State | MA
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Zip | 02453-7003
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Country | US
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Telephone | 781-893-0611
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 7738
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License Number State | MA
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