Provider Demographics
NPI:1528231115
Name:YIM, JIN YONG (LAC)
Entity Type:Individual
Prefix:MR
First Name:JIN YONG
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 1:2532 168TH ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1158
Mailing Address - Country:US
Mailing Address - Phone:718-358-3644
Mailing Address - Fax:718-358-3646
Practice Address - Street 1:2532 168TH ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1158
Practice Address - Country:US
Practice Address - Phone:718-358-3644
Practice Address - Fax:718-358-3646
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003631171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist