Provider Demographics
NPI:1003120973
Name:KIM, YONG H (PSYD)
Entity Type:Individual
Prefix:DR
First Name:YONG
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13004 WILLOWCREST LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-1144
Mailing Address - Country:US
Mailing Address - Phone:405-365-7556
Mailing Address - Fax:
Practice Address - Street 1:428 S MUSTANG RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6754
Practice Address - Country:US
Practice Address - Phone:405-365-7556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200304690AMedicaid