Provider Demographics
NPI:1366315111
Name:IM, YE KYEOM (OTD)
Entity type:Individual
Prefix:
First Name:YE
Middle Name:KYEOM
Last Name:IM
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:CLARA
Other - Middle Name:
Other - Last Name:IM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTD
Mailing Address - Street 1:17146 FIRST LIGHT LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-8710
Mailing Address - Country:US
Mailing Address - Phone:951-269-1031
Mailing Address - Fax:
Practice Address - Street 1:1520 BROOKHOLLOW DR STE 37
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5427
Practice Address - Country:US
Practice Address - Phone:714-953-7330
Practice Address - Fax:949-727-2193
Is Sole Proprietor?:No
Enumeration Date:2025-09-27
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28235225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand