Active NPI
Daesong Yim, PH.D., LAC
- Acupuncturist
- Fairbanks, AK
National Provider Identifier
1053568782
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 117
- Practice address
- 1500 Airport Way # a
Fairbanks, AK 99701-4002 - Phone
- (907) 456-2100
- Fax
- (907) 456-2472
- NPI assigned
- Aug 25, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC00003084 | WA | |
| Acupuncturist | 171100000X | 117 | AK | Primary |
Addresses
Primary practice location
1500 Airport Way # a
Fairbanks, AK 99701-4002
Mailing address
1500 Airport Way # C
Fairbanks, AK 99701-4002
Phone (907) 456-2100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC00003084 | WA | MD | Acupuncturist |
| 117 | AK | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221004800000",
"number": "1053568782",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 AIRPORT WAY # C",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997014002",
"telephone_number": "907-456-2100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 AIRPORT WAY # A",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997014002",
"telephone_number": "907-456-2100",
"fax_number": "907-456-2472"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YIM",
"first_name": "DAESONG",
"name_prefix": "Dr.",
"credential": "PH.D., LAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-25",
"last_updated": "2008-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "WA",
"license": "AC00003084",
"primary": false
},
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "AK",
"license": "117",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.