MEDICARE: DR. WILLIAM JUNGHO 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	D0053771	MD
2	207RR0500X	Rheumatology Physician	ME139857	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306932959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM JUNGHO SHIM M.D.

Provider Business Mailing Address
First Line	:	12513 BRIDGETON DRIVE
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854
Country	:	US
Telephone Number	:	240-631-1036
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 W DR MARTIN LUTHER KING JR BLVD STE 530
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6000
Country	:	US
Telephone Number	:	240-631-1036
Fax Number	:	561-658-6142

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	11/22/2019

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