Individual
ETHAN SHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9225 N 3RD ST, SUITE 304, PHOENIX, AZ 85020
(602) 445-0751
(602) 424-8128
Mailing address
9225 N 3RD ST, SUITE 304, PHOENIX, AZ 85020
(602) 445-0751
(602) 424-8128
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
47765
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
822711
—
AZ
Enumeration date
08/03/2009
Last updated
09/05/2014
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