Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | IL | |
N | 111NS0005X | Chiropractic Sports Physician | IL |
NPI | 1104989144 |
---|---|
Provider Name | Dr. Hong B. Yim |
First Address | Skokie, IL 60076-3259 |
Second Address | Skokie, IL 60076-3259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U72629 | (02) | IL |