Individual
JERRY HYUN SHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1205 RENAISSANCE PKWY STE 240, RIALTO, CA 92376-2418
(909) 746-5000
Mailing address
17736 SAN BERNARDINO AVE, FONTANA, CA 92335-6133
(909) 822-4363
(909) 822-4476
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
43494
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
43494
CA
Other
Enumeration date
01/05/2010
Last updated
02/10/2020
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