Provider Demographics
NPI:1124549134
Name:KIM, YOUNGSUN (DPT, OCS, SCS, MTC)
Entity Type:Individual
Prefix:DR
First Name:YOUNGSUN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DPT, OCS, SCS, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41902 MONTALLEGRO ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-2981
Mailing Address - Country:US
Mailing Address - Phone:661-317-7337
Mailing Address - Fax:
Practice Address - Street 1:38660 MEDICAL CENTER DR # A-280
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4385
Practice Address - Country:US
Practice Address - Phone:661-206-6259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist