Provider Demographics
NPI:1689901050
Name:SUM, YIKMAN
Entity Type:Individual
Prefix:MR
First Name:YIKMAN
Middle Name:
Last Name:SUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 FORT WORTH AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-1746
Mailing Address - Country:US
Mailing Address - Phone:214-941-0926
Mailing Address - Fax:
Practice Address - Street 1:2602 FORT WORTH AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-1746
Practice Address - Country:US
Practice Address - Phone:214-941-0926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist