Provider Demographics
NPI:1093708653
Name:YIM, JOON (MD)
Entity Type:Individual
Prefix:
First Name:JOON
Middle Name:
Last Name:YIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1600 E GUDE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1341
Mailing Address - Country:US
Mailing Address - Phone:301-978-7489
Mailing Address - Fax:301-933-7137
Practice Address - Street 1:1600 E GUDE DR
Practice Address - Street 2:STE 200
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1341
Practice Address - Country:US
Practice Address - Phone:301-978-7489
Practice Address - Fax:301-933-7137
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY223046207ZP0101X
PAMD456689207ZP0101X
MDD0066775207ZP0101X
MDD66775207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC428254YFCTMedicare PIN