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NPI Code Detail

MEDICARE: IM S YI M.D.

MEDICARE: IM S YI M.D.
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
1207Q00000XFamily Medicine Physician01055784IN
2207Q00000XFamily Medicine PhysicianMD00047267WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000373612OTHERINANTHEM

General Provider Information

NPI Number : 1992796650
Entity Type Code : Individual
Provider Name (Legal Business Name) : IM S YI M.D.
Provider Business Mailing Address
First Line : 26004 104TH AVE SE
Second Line :
City : KENT
State : WA
Zip : 98030-7677
Country : US
Telephone Number : 425-251-4040
Fax Number :
Provider Business Practice Location Address
First Line : 26004 104TH AVE SE
Second Line :
City : KENT
State : WA
Zip : 98030-7677
Country : US
Telephone Number : 425-251-4040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 05/12/2021

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Directions to “ IM S YI M.D.” Practice Location

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