Provider Demographics
NPI:1487644522
Name:YIM, PAUL S (M D)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:YIM
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 568
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188
Mailing Address - Country:US
Mailing Address - Phone:615-672-3027
Mailing Address - Fax:
Practice Address - Street 1:128 RAYMOND HIRSCH PKWY
Practice Address - Street 2:SUITE 3
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-8103
Practice Address - Country:US
Practice Address - Phone:615-672-3027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD27718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3802409Medicare ID - Type Unspecified
F83197Medicare UPIN