Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DT-2751 | HI |
NPI | 1093198863 |
---|---|
Provider Name | Dr. Ryan Yim |
First Address | Honolulu, HI 96814-4407 |
Second Address | Honolulu, HI 96814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2015 |
Last Update Date | 16/07/2018 |