Healthcare Provider Details

I. General information

NPI: 1477711034
Provider Name (Legal Business Name): BULIM YIM L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 ROUTE 303 STE 2
BLAUVELT NY
10913-1105
US

IV. Provider business mailing address

580 ROUTE 303 STE 2
BLAUVELT NY
10913-1105
US

V. Phone/Fax

Practice location:
  • Phone: 201-625-3691
  • Fax:
Mailing address:
  • Phone: 201-625-3691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC12025
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007041
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: