David Jung Sug Shim, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

7738 Issued in MA

Practice address

1507 Washington St
West Newton, MA 02465-2219

Phone

(781) 985-5745

NPI assigned

Sep 1, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. David J. Gehrenbeck-Shim Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1283299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283299200000",
    "number": "1124335856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 BEAVER ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024537003",
            "telephone_number": "781-893-0611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 WASHINGTON ST",
            "city": "WEST NEWTON",
            "state": "MA",
            "postal_code": "024652219",
            "telephone_number": "781-985-5745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIM",
        "first_name": "DAVID",
        "middle_name": "JUNG SUG",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-09-01",
        "last_updated": "2010-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "7738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAVID",
            "last_name": "GEHRENBECK-SHIM",
            "middle_name": "J.",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Diane Sartanowicz, ATC, LAT
• Scandinavian Charitable Society of Greater Boston
• Phoebe Kazdin Schnitzer, PHD
• Barbara Schulman, M.D.
• Leah F. Sherman, LICSW
• Tiffany L Simmons
• Susan D Siroty, PSY.D.
• Susan Sklan, LICSW
• Ruth Berniss Smith, PH.D, MSW
• Square Knot Professional Services LLC

• Clinical Psychologist in West Newton, MA
• Providers in West Newton, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.