=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508036781
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELAINE T. SHIM, DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2008
-----------------------------------------------------
Last Update Date | 03/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1550 N GREEN VALLEY PKWY #350
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89074-7108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-567-1887
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1550 N GREEN VALLEY PKWY #350
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89074-7108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-567-1887
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ELAINE T SHIM
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 702-567-1887
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 3525
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------