Provider Demographics
NPI:1306285689
Name:SIM, YOUNG JA (MD)
Entity type:Individual
Prefix:
First Name:YOUNG JA
Middle Name:
Last Name:SIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 PINEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302
Mailing Address - Country:US
Mailing Address - Phone:518-399-0621
Mailing Address - Fax:
Practice Address - Street 1:600 MCCLELLAN ST
Practice Address - Street 2:ALICE HOSPITAL
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304
Practice Address - Country:US
Practice Address - Phone:518-382-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123279207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology