Provider Demographics
NPI:1144261538
Name:SHIM, HYONG W (MD)
Entity type:Individual
Prefix:
First Name:HYONG
Middle Name:W
Last Name:SHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:H
Other - Middle Name:SEAN
Other - Last Name:SHIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:925 COMMERCIAL ST SE STE 102
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4172
Mailing Address - Country:US
Mailing Address - Phone:503-990-7187
Mailing Address - Fax:503-990-7437
Practice Address - Street 1:925 COMMERCIAL ST SE STE 102
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4172
Practice Address - Country:US
Practice Address - Phone:503-990-7187
Practice Address - Fax:503-990-7437
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD072947207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR072947Medicaid
OR1228590005Medicare NSC
ORG05176Medicare UPIN