Provider Demographics
NPI:1033317565
Name:KIM, YONG-SIK (MD)
Entity Type:Individual
Prefix:
First Name:YONG-SIK
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16671 YORBA LINDA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2025
Mailing Address - Country:US
Mailing Address - Phone:714-985-6400
Mailing Address - Fax:
Practice Address - Street 1:16671 YORBA LINDA BLVD STE 100
Practice Address - Street 2:SUITE F
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2025
Practice Address - Country:US
Practice Address - Phone:714-985-6400
Practice Address - Fax:714-985-6425
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6423207R00000X
TXBT23410662951207R00000X
CAA112454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine