MEDICARE: SOON YOUNG 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
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY46931	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5614397	OTHER		OTHER ID NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154371268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOON YOUNG YIM

Provider Business Mailing Address
First Line	:	2681 W OLYMPIC BLVD
Second Line	:	STE 102
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2810
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2681 W OLYMPIC BLVD
Second Line	:	STE 102
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2810
Country	:	US
Telephone Number	:	213-381-7705
Fax Number	:	213-381-7706

Authorized Official
Title or Position	:	OWNER
Name	:	SOON YOUNG YIM
Credential	:	RPH
Telephone Number	:	213-381-7705

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	06/10/2010

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Directions to “SOON YOUNG YIM ” Practice Location

Language	Start Address	Practice Location

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