Basic Information
Provider Information
NPI: 1093380685
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHIM
FirstName: EUN HYE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2800 FOLSOM ST
Address2:  
City: BOULDER
State: CO
PostalCode: 803043738
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2800 FOLSOM ST
Address2:  
City: BOULDER
State: CO
PostalCode: 803043738
CountryCode: US
TelephoneNumber: 3034433993
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/25/2021
LastUpdateDate: 05/25/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/25/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171100000X0002559COY Other Service ProvidersAcupuncturist 

No ID Information.


Home