Provider Demographics
NPI:1306846167
Name:KIM, YOUNG C (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:C
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 1:5655 HUDSON DRIVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4451
Mailing Address - Country:US
Mailing Address - Phone:330-655-3800
Mailing Address - Fax:330-655-3828
Practice Address - Street 1:18697 BAGLEY ROAD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3417
Practice Address - Country:US
Practice Address - Phone:440-816-8770
Practice Address - Fax:440-816-8806
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350458482085R0202X
OH35.0458482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000341983OtherBC/BS INDIVIDUAL PIN NO
OH000000559893OtherANTHEM
OH000000234730OtherUNISON
OH0304914OtherBCMH
OH0448359Medicaid
OHP00600868OtherRAILROAD MEDICARE
OH0304914OtherBCMH
E29758Medicare UPIN
OH000000234730OtherUNISON
OH0448359Medicaid