Provider Demographics
NPI:1396103651
Name:YIM, JANELLE (NP)
Entity type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:
Last Name:YIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3183 WILSHIRE BLVD # 196D36
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1211
Mailing Address - Country:US
Mailing Address - Phone:323-977-0056
Mailing Address - Fax:
Practice Address - Street 1:4500 9TH AVE NE STE 300
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4762
Practice Address - Country:US
Practice Address - Phone:877-622-0229
Practice Address - Fax:425-504-8009
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV836368363LP0808X
CA95003808363LP2300X, 363LF0000X, 363LP0808X
WA61102362363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily