Active NPI
Ivan Yim, MD, PHD
- Surgery Physician
- Milwaukee, WI
National Provider Identifier
1053226373
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 87904-875
- Practice address
- 9200 W Wisconsin Ave
Milwaukee, WI 53226-3522 - Phone
- (414) 955-6900
- Fax
- (414) 955-0079
- NPI assigned
- Aug 19, 2026
- Last updated
- Sep 1, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 87904-875 | WI | Primary |
Addresses
Primary practice location
9200 W Wisconsin Ave
Milwaukee, WI 53226-3522
Mailing address
9200 W Wisconsin Ave
Milwaukee, WI 53226-3522
Phone (414) 955-6900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053226373 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1787097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788220800000",
"number": "1053226373",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9200 W WISCONSIN AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263522",
"telephone_number": "414-955-6900",
"fax_number": "414-955-0079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9200 W WISCONSIN AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263522",
"telephone_number": "414-955-6900",
"fax_number": "414-955-0079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YIM",
"first_name": "IVAN",
"credential": "MD, PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-08-19",
"last_updated": "2026-09-01",
"certification_date": "2026-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WI",
"license": "87904-875",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1053226373",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.