Individual
JAE ROCK SHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1300 N VERMONT AVE, LOS ANGELES, CA 90027-6098
(213) 413-3000
Mailing address
PO BOX 25033, SANTA ANA, CA 92799-5033
(714) 347-1000
(714) 347-1082
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN686691
PA
367500000X
Certified Registered Nurse Anesthetist
209.018963
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
95001105
CA
Other
Enumeration date
01/25/2019
Last updated
08/02/2022
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