Active NPI
Seonjeen Grace Shim, PHARMD
- Pharmacist
- 11003, NY
National Provider Identifier
1407282064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 058434
- Practice address
- 1797 Dutch Broadway
11003, NY 11365-2334 - Phone
- (516) 561-1340
- NPI assigned
- Sep 15, 2013
- Last updated
- Feb 11, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 058434 | NY | Primary |
Addresses
Primary practice location
1797 Dutch Broadway
11003, NY 11365-2334
Mailing address
1797 Dutch Broadway
11003, NY 11365-2334
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 Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 058434 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1379203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392076800000",
"number": "1407282064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1797 DUTCH BROADWAY",
"city": "11003",
"state": "NY",
"postal_code": "113652334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1797 DUTCH BROADWAY",
"city": "11003",
"state": "NY",
"postal_code": "113652334",
"telephone_number": "516-561-1340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIM",
"first_name": "SEONJEEN",
"middle_name": "GRACE",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-09-15",
"last_updated": "2014-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "058434",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.