Provider Demographics
NPI:1235112996
Name:YUM, MIMI RYUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:MIMI
Middle Name:RYUNG
Last Name:YUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 BROOKLINE PL STE 423
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7237
Mailing Address - Country:US
Mailing Address - Phone:617-566-1535
Mailing Address - Fax:617-566-0988
Practice Address - Street 1:1 BROOKLINE PL STE 423
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7237
Practice Address - Country:US
Practice Address - Phone:617-566-1535
Practice Address - Fax:617-566-0988
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-26
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA153790207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3154971Medicaid