Provider Demographics
NPI:1235240219
Name:KIM, YOUNG HAN (MD)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:HAN
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 1:780 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1622
Mailing Address - Country:US
Mailing Address - Phone:781-331-4600
Mailing Address - Fax:781-337-5095
Practice Address - Street 1:780 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1622
Practice Address - Country:US
Practice Address - Phone:781-331-4600
Practice Address - Fax:781-337-5095
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA243032174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA943433OtherNETWORK HEALTH
MA110086537AMedicaid
MA763654OtherTUFTS
MAAA182834OtherHPHC
MA1235240219OtherNEIGHBORHOOD HEALTH
MA1235240219OtherBCBS
MA04-2703199OtherUNITED HEALTH
MA1235240219OtherFALLON
MA763654OtherTUFTS