Provider Demographics
NPI:1306140793
Name:SHIM, JAE H (MD)
Entity type:Individual
Prefix:DR
First Name:JAE
Middle Name:H
Last Name:SHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2 BENJAMIN RD
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2618
Mailing Address - Country:US
Mailing Address - Phone:210-607-0117
Mailing Address - Fax:
Practice Address - Street 1:282 E RTE 4
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5101
Practice Address - Country:US
Practice Address - Phone:551-222-0800
Practice Address - Fax:551-222-0801
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55227-020207Q00000X
NJ25MA11302800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine