Provider Demographics
NPI:1033278973
Name:KIM, YOUNG K (PHD)
Entity Type:Individual
Prefix:MR
First Name:YOUNG
Middle Name:K
Last Name:KIM
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:35 LAWRENCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106
Mailing Address - Country:US
Mailing Address - Phone:413-567-6724
Mailing Address - Fax:413-567-5441
Practice Address - Street 1:155 MAPLE ST
Practice Address - Street 2:STE 301
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1828
Practice Address - Country:US
Practice Address - Phone:413-736-5393
Practice Address - Fax:413-736-5100
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA6044103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04819OtherBLUE CROSS BS
MA000000020085OtherBMC HEALTH NET
MA0520772Medicaid
MA000000020085OtherBMC HEALTH NET