Provider Demographics
NPI:1881916880
Name:YIM, JASON W (LAC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:W
Last Name:YIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 NEWMARKET DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6621
Mailing Address - Country:US
Mailing Address - Phone:240-271-1245
Mailing Address - Fax:301-588-3615
Practice Address - Street 1:7515 NEWMARKET DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-6621
Practice Address - Country:US
Practice Address - Phone:240-271-1245
Practice Address - Fax:301-588-3615
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00846171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist