YOUNG H. KIM, MD, PC

Provider Demographics

• NPI: 1033263678
• Name: YOUNG H. KIM, MD, PC
• Entity Type: Organization
• Organization Name: YOUNG H. KIM, MD, PC
• Other - Org Name: CLARKSTON FAMILY COUNSELING ASSOCIATES
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - First Name: YOUNG
• Authorized Official - Middle Name: H
• Authorized Official - Last Name: KIM
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 248-373-1133
• Mailing Address - Street 1: 2545 N OPDYKE RD
• Mailing Address - Street 2: SUITE 104
• Mailing Address - City: AUBURN HILLS
• Mailing Address - State: MI
• Mailing Address - Zip Code: 48326-1970
• Mailing Address - Country: US
• Mailing Address - Phone: 248-373-1133
• Mailing Address - Fax: 248-373-1140
• Practice Address - Street 1: 2545 N OPDYKE RD
• Practice Address - Street 2: SUITE 104
• Practice Address - City: AUBURN HILLS
• Practice Address - State: MI
• Practice Address - Zip Code: 48326-1970
• Practice Address - Country: US
• Practice Address - Phone: 248-373-1133
• Practice Address - Fax: 248-373-1140
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-01-22
• Last Update Date: 2013-06-24

Provider Licenses

State	License ID	Taxonomies
MI	6301009503	103TC0700X
MI	6301006011	103TC0700X
MI	6801033761	1041C0700X
MI	6801066233	1041C0700X
MI	6801068002	1041C0700X
MI	6801010010	1041C0700X
MI	4301040478	2084P0800X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty
No	103TC0700X	Behavioral Health & Social Service Providers	Psychologist	Clinical	Group - Multi-Specialty
No	1041C0700X	Behavioral Health & Social Service Providers	Social Worker	Clinical	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MI	2606374792	Other	BLUE CROSS BLUE SHIELD
MI	8008965160	Other	BLUE CROSS BLUE SHIELD
MI	8008965400	Other	BLUE CROSS BLUE SHIELD
MI	680F333020	Other	BLUE CROSS BLUE SHIELD
MI	680F331960	Other	BLUE CROSS BLUE SHIELD
MI	8008969050	Other	BLUE CROSS BLUE SHIELD
	8008908390	Other	BLUE CROSS BLUE SHIELD
	8008908390	Other	BLUE CROSS BLUE SHIELD
MI	P12210005	Medicare PIN
MI	0637479	Medicare PIN
MI	P12210006	Medicare PIN
MI	P12210001	Medicare PIN
MI	680F331960	Other	BLUE CROSS BLUE SHIELD
MI	2606374792	Other	BLUE CROSS BLUE SHIELD
	0N94820	Medicare PIN
MI	P12210004	Medicare PIN
MI	P12210002	Medicare PIN