Healthcare Provider Details

I. General information

NPI: 1750273140
Provider Name (Legal Business Name): JOANNE YIM
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SAN LEANDRO BLVD
SAN LEANDRO CA
94577-1595
US

IV. Provider business mailing address

1100 SAN LEANDRO BLVD
SAN LEANDRO CA
94577-1595
US

V. Phone/Fax

Practice location:
  • Phone: 510-268-2273
  • Fax:
Mailing address:
  • Phone: 510-268-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number29201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: