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General NPI Number Information
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NPI Number | 1215713748
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Entity Type | Individual
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Provider Name | JAE YOON IM
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Gender | Male
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Dates
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Enumeration Date | 08/31/2023
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 4100 W ALAMEDA AVE # 346
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City | BURBANK
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State | CA
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Zip | 91505-4195
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Country | US
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Telephone | 818-900-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 940 ELDEN AVE UNIT 302
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City | LOS ANGELES
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State | CA
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Zip | 90006-5845
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Country | US
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Telephone | 310-386-7768
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT23705
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License Number State | CA
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