Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 219451 | NY |
NPI | 1134116445 |
---|---|
Provider Name | Dr. Thomas Youm |
First Address | New York, NY 10028-0112 |
Second Address | New York, NY 10028-0112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2005 |
Last Update Date | 05/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I12838 | (02) | NY |
P00700189 | RR MCR (01) | NY |