Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | D0063550 | MD |
NPI | 1033134044 |
---|---|
Provider Name | Lily T Im |
First Address | Baltimore, MD 21201-1734 |
Second Address | Baltimore, MD 21201-1734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 14/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I13412 | (02) |