Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A119516 | CA |
Y | 207Q00000X | Family Doctor | MD60366594 | WA |
NPI | 1003136979 |
---|---|
Provider Name | Raynald H Im |
First Address | Everett, WA 98206-5127 |
Second Address | Everett, WA 98201-4833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2010 |
Last Update Date | 20/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G8922311 | (02) | WA |