Healthcare Provider Details

I. General information

NPI: 1285848218
Provider Name (Legal Business Name): HAE SU YIM D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 W 5TH ST
MARYSVILLE OH
43040-9282
US

IV. Provider business mailing address

5041 VAIL PINE PL
DUBLIN OH
43016-9463
US

V. Phone/Fax

Practice location:
  • Phone: 937-642-2400
  • Fax: 937-642-2490
Mailing address:
  • Phone: 614-599-0065
  • Fax: 937-642-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: