Provider Demographics
NPI:1164875977
Name:YIM, DAYNA (OD)
Entity Type:Individual
Prefix:
First Name:DAYNA
Middle Name:
Last Name:YIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3059 MAIGRET ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-1930
Mailing Address - Country:US
Mailing Address - Phone:808-222-5305
Mailing Address - Fax:
Practice Address - Street 1:1107 NE 9TH AVE
Practice Address - Street 2:APT #325
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3629
Practice Address - Country:US
Practice Address - Phone:808-222-5305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-16
Last Update Date:2016-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3673AT152W00000X
HIOD843152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist