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NPI Code Detail

MEDICARE: DR. STACEY ANN YIM

MEDICARE: DR. STACEY ANN YIM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist945HI

General Provider Information

NPI Number : 1104025022
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACEY ANN YIM
Provider Business Mailing Address
First Line : 91-1841 FORT WEAVER RD
Second Line :
City : EWA BEACH
State : HI
Zip : 96706-1909
Country : US
Telephone Number : 808-778-8661
Fax Number :
Provider Business Practice Location Address
First Line : 91-1841 FORT WEAVER RD
Second Line :
City : EWA BEACH
State : HI
Zip : 96706-1909
Country : US
Telephone Number : 808-778-8661
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2007
Last Update Date : 12/17/2015

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Directions to “ DR. STACEY ANN YIM ” Practice Location

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