Healthcare Provider Details

I. General information

NPI: 1215033220
Provider Name (Legal Business Name): ALLISON ROSE YIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 S SIERRA MADRE BLVD
PASADENA CA
91107-5240
US

IV. Provider business mailing address

504 S SIERRA MADRE BLVD
PASADENA CA
91107-5240
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-8811
  • Fax: 626-795-0953
Mailing address:
  • Phone: 626-795-8811
  • Fax: 626-795-0953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG080624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: