Provider Demographics
NPI:1669342002
Name:YIM, DAN YOL (LMT)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:YOL
Last Name:YIM
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 ABBOTT AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-2502
Mailing Address - Country:US
Mailing Address - Phone:201-682-8387
Mailing Address - Fax:
Practice Address - Street 1:410 ABBOTT AVE FL 2
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-2502
Practice Address - Country:US
Practice Address - Phone:201-682-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-10
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01013700225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist