Provider Demographics
NPI:1992989172
Name:YIM, JUNGBIN JAY (LDO)
Entity type:Individual
Prefix:MR
First Name:JUNGBIN
Middle Name:JAY
Last Name:YIM
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 180TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-7910
Mailing Address - Country:US
Mailing Address - Phone:425-245-3446
Mailing Address - Fax:425-745-2379
Practice Address - Street 1:2215 180TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-7910
Practice Address - Country:US
Practice Address - Phone:425-245-3446
Practice Address - Fax:425-745-2379
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO00001924156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician