=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669342002
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAN YOL YIM LMT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2025
-----------------------------------------------------
Last Update Date | 11/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 ABBOTT AVE FL 2
-----------------------------------------------------
City | RIDGEFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07657-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-682-8387
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 410 ABBOTT AVE FL 2
-----------------------------------------------------
City | RIDGEFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07657-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-682-8387
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 18KT01013700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------