Active NPI
Ji Hyun Shim
- General Practice Dentistry
- Chicago, IL
National Provider Identifier
1811507742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019032863
- Practice address
- 6560 W Fullerton Ave Unit C106
Chicago, IL 60707-3439 - Phone
- (773) 385-6700
- NPI assigned
- Aug 5, 2020
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019032863 | IL | Primary |
Addresses
Primary practice location
6560 W Fullerton Ave Unit C106
Chicago, IL 60707-3439
Mailing address
5345 Sepulveda Blvd Apt 122
Sherman Oaks, CA 91411-3460
Phone (818) 480-8142
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260608001419 | CA | Order and Referring Only - Dentist | 9638640980 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019032863 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596585600000",
"number": "1811507742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5345 SEPULVEDA BLVD APT 122",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "914113460",
"telephone_number": "818-480-8142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6560 W FULLERTON AVE UNIT C106",
"city": "CHICAGO",
"state": "IL",
"postal_code": "607073439",
"telephone_number": "773-385-6700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIM",
"first_name": "JI HYUN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-05",
"last_updated": "2020-08-05",
"certification_date": "2020-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019032863",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.