Provider Demographics
NPI:1386162576
Name:YIM, NYEONJAE (LAC)
Entity type:Individual
Prefix:
First Name:NYEONJAE
Middle Name:
Last Name:YIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 TIMBERWOOD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-0281
Mailing Address - Country:US
Mailing Address - Phone:714-788-8910
Mailing Address - Fax:657-387-0555
Practice Address - Street 1:101 N BASQUE AVE STE A
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-2753
Practice Address - Country:US
Practice Address - Phone:714-788-8910
Practice Address - Fax:657-387-0555
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16298171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist