Active NPI
Chungja C Shim
- Anatomic Pathology & Clinical Pathology Physician
- Titusville, PA
National Provider Identifier
1437269685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- MD02206SE
- Practice address
- 406 W Oak Street
Titusville Area Hospital
Titusville, PA 16354 - Phone
- (814) 827-1851
- Fax
- (814) 827-7259
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | MD02206SE | PA | Primary |
Addresses
Primary practice location
406 W Oak Street
Titusville Area Hospital
Titusville, PA 16354
Mailing address
PO Box 28
Washington, PA 15301
Phone (724) 228-3400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 009579700001 | Medicaid | PA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD02206SE | PA | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1437269685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 28",
"city": "WASHINGTON",
"state": "PA",
"postal_code": "15301",
"telephone_number": "724-228-3400",
"fax_number": "724-228-7040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "406 W OAK STREET",
"address_2": "TITUSVILLE AREA HOSPITAL",
"city": "TITUSVILLE",
"state": "PA",
"postal_code": "16354",
"telephone_number": "814-827-1851",
"fax_number": "814-827-7259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIM",
"first_name": "CHUNGJA",
"middle_name": "C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "PA",
"license": "MD02206SE",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009579700001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Titusville, PA
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.