Provider Demographics
NPI:1083701007
Name:YIM, YUNG (MD)
Entity Type:Individual
Prefix:MR
First Name:YUNG
Middle Name:
Last Name:YIM
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:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368
Mailing Address - Country:US
Mailing Address - Phone:209-577-9900
Mailing Address - Fax:209-577-1509
Practice Address - Street 1:5275 F STREET
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819
Practice Address - Country:US
Practice Address - Phone:209-577-9900
Practice Address - Fax:209-577-1509
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA451282080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A451280Medicaid
CA00A451280Medicaid
CA00A451280Medicare ID - Type Unspecified