Healthcare Provider Details

I. General information

NPI: 1790276111
Provider Name (Legal Business Name): YE JEE SHIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 KEAR STREET
YORKTOWN HEIGHTS NY
10598
US

IV. Provider business mailing address

334 KEAR STREET
YORKTOWN HEIGHTS NY
10598
US

V. Phone/Fax

Practice location:
  • Phone: 914-245-7575
  • Fax: 718-630-3244
Mailing address:
  • Phone: 914-245-7575
  • Fax: 718-630-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number060411
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number060411
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: