Active NPI
Dong Yup Shim, M.D.
- Psychiatry Physician
- Buffalo, NY
National Provider Identifier
1396756458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 118978
- Practice address
- 3495 Bailey Ave
Buffalo, NY 14215-1129 - Phone
- (716) 834-9200
- NPI assigned
- Aug 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 118978 | NY | Primary |
Addresses
Primary practice location
3495 Bailey Ave
Buffalo, NY 14215-1129
Mailing address
17 Boundbrook CT
East Amherst, NY 14051-1653
Phone (716) 688-8897
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 118978 | NY | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1396756458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 BOUNDBROOK CT",
"city": "EAST AMHERST",
"state": "NY",
"postal_code": "140511653",
"telephone_number": "716-688-8897"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3495 BAILEY AVE",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142151129",
"telephone_number": "716-834-9200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIM",
"first_name": "DONG YUP",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NY",
"license": "118978",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.