Provider Demographics
NPI:1083793798
Name:KIM, YOUNG HO (MD PC)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:HO
Last Name:KIM
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5639 SASHABAW RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3149
Mailing Address - Country:US
Mailing Address - Phone:248-922-9077
Mailing Address - Fax:248-922-9040
Practice Address - Street 1:5639 SASHABAW RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3149
Practice Address - Country:US
Practice Address - Phone:248-922-9077
Practice Address - Fax:248-922-9040
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010404782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI036185OtherVALUE OPTIONS
MIA73289OtherHEALTH ALLIANCE PLAN
MI2606374792OtherBLUE CROSS BLUE SHIELD
278069000OtherMAGELLAN
4417209OtherAETNA
MI2606374792OtherBLUE CROSS BLUE SHIELD
A73289Medicare UPIN
MIP12210004Medicare PIN
MI0637479Medicare PIN