Individual provider Active NPI

Deborah Yim

  • Pediatric Dentistry
  • Hammond, LA
National Provider Identifier
1063865285
Registry record updated Dec 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
6692 Issued in LA
Practice address
1500 Bauerle Rd.
BLDG 100, Suite B
Hammond, LA 70403
Phone
(985) 510-2654
Fax
(985) 510-2655
NPI assigned
Jul 22, 2016
Last updated
Dec 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 6692 LA Primary

Addresses

Primary practice location

1500 Bauerle Rd.
BLDG 100, Suite B
Hammond, LA 70403

Mailing address

1459 Aztec Ave
Metairie, LA 70005-1205
Phone (224) 217-7110

Other practice location 1

102 Fontainbleau Dr Ste F2
Mandeville, LA 70471-6519
Phone (985) 317-0656

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160922000147 LA Order and Referring Only - DentistPractitioner - Dentist 9638466436

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6692LAMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Stephanie Barlow DDS LLC Pediatric Dentistry CurrentSince Aug 1, 2024 Accepting new patients
Deborah Yim, DMD, LLC Pediatric Dentistry CurrentSince Aug 25, 2024 Accepting new patients

Locations

1500 Bauerle Rd
Bldg 100
Hammond, LA 70403
Phone (985) 510-2654

102 Fontainbleau Dr
Ste F2
Mandeville, LA 70471
Phone (864) 641-5511

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734998400000",
    "number": "1063865285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1459 AZTEC AVE",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700051205",
            "telephone_number": "224-217-7110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 BAUERLE RD.",
            "address_2": "BLDG 100, SUITE B",
            "city": "HAMMOND",
            "state": "LA",
            "postal_code": "70403",
            "telephone_number": "985-510-2654",
            "fax_number": "985-510-2655"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "102 Fontainbleau Dr Ste F2",
            "address_purpose": "LOCATION",
            "city": "Mandeville",
            "state": "LA",
            "postal_code": "704716519",
            "country_code": "US",
            "telephone_number": "985-317-0656",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YIM",
        "first_name": "DEBORAH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-22",
        "last_updated": "2024-12-24",
        "certification_date": "2024-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "LA",
            "license": "6692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hammond, LA

Sources for this page

Verify at the official NPI Registry.