Provider Demographics
NPI:1902423593
Name:SHIM, TREVOR ANDREW
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:ANDREW
Last Name:SHIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 MOUNTAIN CREEK RD APT 209
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-1650
Mailing Address - Country:US
Mailing Address - Phone:478-396-7898
Mailing Address - Fax:
Practice Address - Street 1:1185 MOUNTAIN CREEK RD APT 209
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-1650
Practice Address - Country:US
Practice Address - Phone:478-396-7898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program