Sooyeon Shim, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D10290 Issued in OR

Practice address

4410 SE 82ND Ave Ste 2050
Portland, OR 97266-2955

Phone

(503) 771-0081

Fax

(503) 772-2272

NPI assigned

Jul 27, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eastport Plaza Dental P.C.

  • General Practice Dentistry
  • Portland, OR
  • NPI 1699927863
  NPD (past)

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

{
    "created_epoch": "1437955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437955200000",
    "number": "1487039897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4410 SE 82ND AVE STE 2050",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972662955",
            "telephone_number": "503-771-0081",
            "fax_number": "503-772-2272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 SE 82ND AVE STE 2050",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972662955",
            "telephone_number": "503-771-0081",
            "fax_number": "503-772-2272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIM",
        "first_name": "SOOYEON",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-27",
        "last_updated": "2015-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D10290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel Gardner Shiley, MD
• Casey Shillam, RN
• Eric William Shilland, D.O.
• Joel M. Shilling, M.D.
• Jeni Lynne Shilman, LCSW
• Uhng-Choon Brenda Shim, M.D.
• Jason Shima
• Robert Shimabukuro
• Amber Lynn Shimamoto
• Sara Elizabeth Shimanek, MD

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2015; 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.