Jae Myung Shim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

1800 Grand Ave
Waukegan, IL 60085-3582

Phone

(847) 336-4180

Fax

(847) 336-4190

NPI assigned

Mar 9, 2007

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669504221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600853582",
            "telephone_number": "847-336-4180",
            "fax_number": "847-336-4190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600853582",
            "telephone_number": "847-336-4180",
            "fax_number": "847-336-4190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIM",
        "first_name": "JAE",
        "middle_name": "MYUNG",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1004816",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joann L Sherman
• Nicholas Ryan Sherman
• Bria Nicole Sherrod
• Pearlie Sherrod
• Jack Sherwood
• Amy Judith Shimoni, MED DT
• Chae Shin
• Golda Shobert, CNM
• Kiera Rose Shorey, MSW
• Kristine Ann Sigafus

• General Practice Dentistry in Waukegan, IL
• Providers in Waukegan, IL by specialty
• General Practice Dentistry in Illinois

• 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.

Verify at the official NPI Registry.