Healthcare Provider Details

I. General information

NPI: 1083701007
Provider Name (Legal Business Name): YUNG YIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 F STREET
SACRAMENTO CA
95819
US

IV. Provider business mailing address

PO BOX 906
SALIDA CA
95368
US

V. Phone/Fax

Practice location:
  • Phone: 209-577-9900
  • Fax: 209-577-1509
Mailing address:
  • Phone: 209-577-9900
  • Fax: 209-577-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberA45128
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: