Healthcare Provider Details

I. General information

NPI: 1235503343
Provider Name (Legal Business Name): RYAN YIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 S TORREY PINES DR
LAS VEGAS NV
89118-3258
US

IV. Provider business mailing address

3198 JEVONDA AVE
LAS VEGAS NV
89044-0382
US

V. Phone/Fax

Practice location:
  • Phone: 303-912-1062
  • Fax:
Mailing address:
  • Phone: 303-912-1062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number4331
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: