Provider Demographics
NPI:1861710717
Name:SHIM, UNJOO ELLEN (PHARMD)
Entity type:Individual
Prefix:
First Name:UNJOO
Middle Name:ELLEN
Last Name:SHIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:UNJOO
Other - Last Name:SHIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1208 W REDONDO BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3411
Mailing Address - Country:US
Mailing Address - Phone:310-323-4768
Mailing Address - Fax:
Practice Address - Street 1:1208 W REDONDO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3411
Practice Address - Country:US
Practice Address - Phone:310-323-4768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490761835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy