Healthcare Provider Details

I. General information

NPI: 1952622417
Provider Name (Legal Business Name): EUGENE SUN YIM M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21115 NEWPORT COAST DR
NEWPORT BEACH CA
92657-1122
US

IV. Provider business mailing address

PO BOX 31001-2703
PASADENA CA
91110-2703
US

V. Phone/Fax

Practice location:
  • Phone: 949-557-0728
  • Fax: 949-557-0731
Mailing address:
  • Phone: 949-557-0728
  • Fax: 949-557-0731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberA124638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: