Healthcare Provider Details

I. General information

NPI: 1699947515
Provider Name (Legal Business Name): ANGELA M YIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FIRST AVE AT 16TH ST BETH ISRAEL MEDICAL CENTER
NEW YORK NY
10003
US

IV. Provider business mailing address

425 E 13TH ST 4N
NEW YORK NY
10009-3592
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-4580
  • Fax:
Mailing address:
  • Phone: 917-494-2067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number247854
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number247854
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: