Healthcare Provider Details

I. General information

NPI: 1790377273
Provider Name (Legal Business Name): CHAERIN YEOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2021
Last Update Date: 02/06/2021
Certification Date: 01/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3992 CENTRAL CAMPUS DRIVE DEPT 3504
OGDEN UT
84408
US

IV. Provider business mailing address

3848 HARRISON BLVD
OGDEN UT
84408-0001
US

V. Phone/Fax

Practice location:
  • Phone: 801-626-7656
  • Fax:
Mailing address:
  • Phone: 801-626-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: