Healthcare Provider Details

I. General information

NPI: 1437185469
Provider Name (Legal Business Name): CHARLES D YIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7253 AMBASSADOR RD
BALTIMORE MD
21244-2710
US

IV. Provider business mailing address

7253 AMBASSADOR RD
BALTIMORE MD
21244-2710
US

V. Phone/Fax

Practice location:
  • Phone: 443-436-1116
  • Fax: 443-436-1256
Mailing address:
  • Phone: 443-436-1116
  • Fax: 443-436-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0055366
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: