Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 33421TLG | CA |
NPI | 1003265588 |
---|---|
Provider Name | Christine Yim |
First Address | San Rafael, CA 94903-5233 |
Second Address | San Rafael, CA 94903-5233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2016 |
Last Update Date | 29/03/2018 |