Provider Demographics
NPI:1063483667
Name:YU, KIM K (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:K
Last Name:YU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-2833
Mailing Address - Fax:989-583-1440
Practice Address - Street 1:5570 STATE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3583
Practice Address - Country:US
Practice Address - Phone:989-583-0100
Practice Address - Fax:989-583-0108
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080H232630OtherBCBS GROUP
MI080H232630OtherBCN GROUP
MI4397890-10Medicaid
MI1063483667Medicaid
MI0808290401OtherBCBS BCN
MI080H232630OtherBCBS GROUP
MI0808290401OtherBCBS BCN
MI0N50880Medicare PIN