Healthcare Provider Details

I. General information

NPI: 1760102388
Provider Name (Legal Business Name): YOOJIN YIM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 59TH ST RM 8A
NEW YORK NY
10022-1864
US

IV. Provider business mailing address

210 SISKIYOU CT
WALNUT CREEK CA
94598-2115
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-6160
  • Fax:
Mailing address:
  • Phone: 925-586-8198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number031466
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: