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General NPI Number Information
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NPI Number | 1225225519
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Entity Type | Individual
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Provider Name | SIMON D YIM MD
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Gender | Male
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 1166 SAINT GEORGES AVE
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City | AVENEL
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State | NJ
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Zip | 07001-1263
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Country | US
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Telephone | 732-636-6113
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Fax | 732-636-1006
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Provider Business Mailing Address
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Address Line | 1166 SAINT GEORGES AVE
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City | AVENEL
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State | NJ
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Zip | 07001-1263
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Country | US
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Telephone | 732-636-6113
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Fax | 732-636-1006
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MA51164
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License Number State | NJ
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