Healthcare Provider Details

I. General information

NPI: 1447143094
Provider Name (Legal Business Name): JEFFREY JANGSOON YIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114
US

IV. Provider business mailing address

202-6999 CAMBIE ST
VANCOUVER B.C.
V6P 051
CA

V. Phone/Fax

Practice location:
  • Phone: 778-689-1450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number3017666
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: