Provider Demographics
NPI:1962761635
Name:IM, YOUNG HEE
Entity type:Individual
Prefix:MRS
First Name:YOUNG HEE
Middle Name:
Last Name:IM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1460
Mailing Address - Country:US
Mailing Address - Phone:917-453-8393
Mailing Address - Fax:
Practice Address - Street 1:31 OLD ROUTE 7
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-1711
Practice Address - Country:US
Practice Address - Phone:917-453-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000392171100000X
NY002377171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist