Provider Demographics
NPI:1093856668
Name:KIM, YUNG H (MD)
Entity Type:Individual
Prefix:DR
First Name:YUNG
Middle Name:H
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 1:983 HUNTERS TURN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-3309
Mailing Address - Country:US
Mailing Address - Phone:215-947-6634
Mailing Address - Fax:215-947-6634
Practice Address - Street 1:446 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-4502
Practice Address - Country:US
Practice Address - Phone:609-394-4019
Practice Address - Fax:609-394-4685
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04769600207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0225703Medicaid
NJD90462Medicare UPIN
NJ130861Medicare ID - Type Unspecified