Provider Demographics
NPI:1124203849
Name:MA, YIMIN
Entity Type:Individual
Prefix:MS
First Name:YIMIN
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:YIMIN
Other - Middle Name:MA
Other - Last Name:ZELDIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13825 31ST DRIVE
Mailing Address - Street 2:6G
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-886-6022
Mailing Address - Fax:718-886-6022
Practice Address - Street 1:13825 31ST DRIVE
Practice Address - Street 2:6G
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-886-6022
Practice Address - Fax:718-886-6022
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246390164W00000X
NY624171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No164W00000XNursing Service ProvidersLicensed Practical Nurse