Healthcare Provider Details

I. General information

NPI: 1336602861
Provider Name (Legal Business Name): HYESUNG YIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 N US HIGHWAY 287
LAFAYETTE CO
80026-8955
US

IV. Provider business mailing address

745 N US HIGHWAY 287
LAFAYETTE CO
80026-8955
US

V. Phone/Fax

Practice location:
  • Phone: 303-666-0434
  • Fax:
Mailing address:
  • Phone: 303-666-0434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16353
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: