MEDICARE: DR. JOSEPH Y SHIM M.D.

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	213823	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	113508930	OTHER	NY	TAX ID
2	P1895653	OTHER	NY	OXFORD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2325482	OTHER	NY	AETNA
5	196315A	OTHER	NY	MAGNACARE
6	831931	OTHER	NY	BLUE CROSS BLUE SHIELDS

General Provider Information

NPI Number	:	1285640730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH Y SHIM M.D.

Provider Business Mailing Address
First Line	:	5650 FRANCIS LEWIS BLVD FL 1
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-1635
Country	:	US
Telephone Number	:	718-279-8107
Fax Number	:	718-279-8101

Provider Business Practice Location Address
First Line	:	5650 FRANCIS LEWIS BLVD FL 1
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-1635
Country	:	US
Telephone Number	:	718-279-8107
Fax Number	:	718-279-8101

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. JOSEPH Y SHIM M.D.” Practice Location

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