Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OEG001452 | PA |
NPI | 1003860255 |
---|---|
Provider Name | Dr. Ka-Eul Kelly Yim |
First Address | Cheltenham, PA 19012-1412 |
Second Address | Cheltenham, PA 19012-1412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 15/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1745507 | PA BLUE SHIELD (01) | PA |
V08137 | (02) | PA |