Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 7953T | CA |
NPI | 1003969650 |
---|---|
Provider Name | Dr. Teresa Ann Yim |
First Address | Livermore, CA 94550-4454 |
Second Address | Livermore, CA 94550-4454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MY0648470 | DEA REGISTRATION NUMBER (01) | CA |
SD0079530 | (05) | CA |