Healthcare Provider Details

I. General information

NPI: 1457609745
Provider Name (Legal Business Name): JUDIE R YIM LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2012
Last Update Date: 08/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W 13TH ST STE 1B
NEW YORK NY
10011-7746
US

IV. Provider business mailing address

230 W 13TH ST STE 1B
NEW YORK NY
10011-7746
US

V. Phone/Fax

Practice location:
  • Phone: 347-284-0086
  • Fax:
Mailing address:
  • Phone: 347-284-0086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number019057
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: