Provider Demographics
NPI:1306846951
Name:YIM, HO (DPM)
Entity Type:Individual
Prefix:DR
First Name:HO
Middle Name:
Last Name:YIM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SHILOH ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4815
Mailing Address - Country:US
Mailing Address - Phone:646-423-0625
Mailing Address - Fax:718-513-1112
Practice Address - Street 1:4231 COLDEN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3977
Practice Address - Country:US
Practice Address - Phone:718-961-9593
Practice Address - Fax:718-961-9594
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006039213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02611181Medicaid
NYPJ5931Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NY06707Medicare ID - Type UnspecifiedGHI MEDICARE
NY02611181Medicaid