Provider Demographics
NPI:1477711034
Name:YIM, BULIM (LAC)
Entity Type:Individual
Prefix:MR
First Name:BULIM
Middle Name:
Last Name:YIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 ROUTE 303 STE 2
Mailing Address - Street 2:
Mailing Address - City:BLAUVELT
Mailing Address - State:NY
Mailing Address - Zip Code:10913-1105
Mailing Address - Country:US
Mailing Address - Phone:201-625-3691
Mailing Address - Fax:
Practice Address - Street 1:580 ROUTE 303 STE 2
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-1105
Practice Address - Country:US
Practice Address - Phone:201-625-3691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12025171100000X
NY007041171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist