Provider Demographics
NPI:1225353022
Name:KIM, SONYA YOUNG (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:SONYA
Middle Name:YOUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:DR
Other - First Name:SONYA
Other - Middle Name:YOUNG
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 DEVONSHIRE BLVD APT 8
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-1758
Mailing Address - Country:US
Mailing Address - Phone:415-314-1005
Mailing Address - Fax:888-959-8346
Practice Address - Street 1:1 DEVONSHIRE BLVD APT 8
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-1758
Practice Address - Country:US
Practice Address - Phone:415-314-1005
Practice Address - Fax:888-959-8346
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79002207PT0002X, 207PS0010X, 207P00000X, 207PE0004X, 207PP0204X, 207PE0005X, 207PH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
No207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD 12795OtherHI STATE MEDICAL LICENSE
CAA79002OtherCA STATE MEDICAL LICENSE
CAA79002OtherCA STATE MEDICAL LICENSE