Provider Demographics
NPI:1710784111
Name:LHUNGDIM, SHOMINLUN
Entity type:Individual
Prefix:
First Name:SHOMINLUN
Middle Name:
Last Name:LHUNGDIM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9922 S 66TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6203
Mailing Address - Country:US
Mailing Address - Phone:918-209-8958
Mailing Address - Fax:
Practice Address - Street 1:2488 E 81ST ST # 2045
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4290
Practice Address - Country:US
Practice Address - Phone:918-388-7017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator