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General NPI Number Information
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NPI Number | 1588676415
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Entity Type | Individual
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Provider Name | S. CHRISTOPHER SHIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 415 E COOK RD STE 500
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City | FORT WAYNE
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State | IN
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Zip | 46825-3657
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Country | US
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Telephone | 260-969-9696
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Fax | 260-969-7979
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Provider Business Mailing Address
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Address Line | 11012 W SYCAMORE HILLS DR
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City | FORT WAYNE
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State | IN
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Zip | 46814-9308
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Country | US
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Telephone | 260-615-1216
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 01035698A
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License Number State | IN
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