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General NPI Number Information
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NPI Number | 1053568782
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Entity Type | Individual
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Provider Name | DAESONG YIM PH.D., LAC
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Gender | Male
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Dates
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Enumeration Date | 08/25/2008
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 1500 AIRPORT WAY # A
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City | FAIRBANKS
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State | AK
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Zip | 99701-4002
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Country | US
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Telephone | 907-456-2100
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Fax | 907-456-2472
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Provider Business Mailing Address
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Address Line | 1500 AIRPORT WAY # C
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City | FAIRBANKS
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State | AK
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Zip | 99701-4002
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Country | US
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Telephone | 907-456-2100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC00003084
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 117
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License Number State | AK
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