Provider Demographics
NPI:1992357255
Name:YIM, KAITY (MSTOM, LAC)
Entity Type:Individual
Prefix:MS
First Name:KAITY
Middle Name:
Last Name:YIM
Suffix:
Gender:F
Credentials:MSTOM, LAC
Other - Prefix:
Other - First Name:KAI
Other - Middle Name:
Other - Last Name:YIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:310 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1643
Mailing Address - Country:US
Mailing Address - Phone:845-418-0809
Mailing Address - Fax:
Practice Address - Street 1:265 N HIGHLAND AVE STE 105
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1444
Practice Address - Country:US
Practice Address - Phone:845-418-0809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist