Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 259673 | NY |
Y | 207RG0100X | Gastroenterologist | 259673 | NY |
NPI | 1730497454 |
---|---|
Provider Name | Dr. Gene Young Im |
First Address | New York, NY 10029-6574 |
Second Address | New York, NY 10029-6501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2010 |
Last Update Date | 17/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
259673 | NEW YORK STATE LICENSE (01) | NY |