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General NPI Number Information
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NPI Number | 1588907802
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Entity Type | Individual
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Provider Name | JENNIFER SHIN YIM PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/04/2013
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 1650 S EUCLID AVE
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City | ONTARIO
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State | CA
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Zip | 91762-5824
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Country | US
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Telephone | 909-391-4138
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Fax |
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Provider Business Mailing Address
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Address Line | 1650 S EUCLID AVE
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City | ONTARIO
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State | CA
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Zip | 91762-5824
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Country | US
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Telephone | 909-391-4138
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Fax | 909-391-4395
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA22803
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License Number State | CA
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