MEDICARE: CAROLINE SHIM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A76783	CA
2	208000000X	Pediatrics Physician	A76783	CA

General Provider Information

NPI Number	:	1043359284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE SHIM MD

Provider Business Mailing Address
First Line	:	910 VIA DE LA PAZ
Second Line	:	SUITE 207
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-3515
Country	:	US
Telephone Number	:	310-454-4466
Fax Number	:	310-454-0916

Provider Business Practice Location Address
First Line	:	881 ALMA REAL DR STE 316
Second Line	:
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-5061
Country	:	US
Telephone Number	:	310-454-2296
Fax Number	:	310-454-2295

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	01/25/2024

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Directions to “ CAROLINE SHIM MD” Practice Location

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