Healthcare Provider Details

I. General information

NPI: 1396738191
Provider Name (Legal Business Name): PHILLIP YIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W MACPHAIL RD SUITE 107
BEL AIR MD
21014-4309
US

IV. Provider business mailing address

615 W MACPHAIL RD SUITE 107
BEL AIR MD
21014-4309
US

V. Phone/Fax

Practice location:
  • Phone: 410-838-9555
  • Fax: 410-836-5056
Mailing address:
  • Phone: 410-838-9555
  • Fax: 410-836-5056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0011958
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: