Healthcare Provider Details

I. General information

NPI: 1669342002
Provider Name (Legal Business Name): DAN YOL YIM LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 ABBOTT AVE FL 2
RIDGEFIELD NJ
07657-2502
US

IV. Provider business mailing address

410 ABBOTT AVE FL 2
RIDGEFIELD NJ
07657-2502
US

V. Phone/Fax

Practice location:
  • Phone: 201-682-8387
  • Fax:
Mailing address:
  • Phone: 201-682-8387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT01013700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: