Shim, Jae Myung
Shim, Jae Myung is an sole proprietor health care provider with primary practice located at 1800 Grand Ave , Waukegan IL 60085-3582. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Shim, Jae Myung can be contacted via phone (847) 336-4180.Contact Information
Primary practice address
1800 Grand Ave
Waukegan IL 60085-3582
Phone: (847) 336-4180
Fax: (847) 336-4190
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | Illinois |
Profile Details
| NPI number | 1669504221 |
|---|---|
| LBN Legal business name | Shim, Jae Myung |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 9th, 2007 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1669504221 | NPPES |
| Illinois | MEDICAID | 1004816 |
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