Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0105X | Surgery of the Hand | G64525 | CA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | G64525 | CA |
NPI | 1417043084 |
---|---|
Provider Name | Kenneth Kai-Yuk Yim |
First Address | San Jose, CA 95128-2604 |
Second Address | San Jose, CA 95128-2604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 12/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G645250 | (05) | CA |
E89778 | (02) | CA |