Provider Demographics
NPI:1326258286
Name:KIM, YOUNG SUN
Entity Type:Individual
Prefix:MR
First Name:YOUNG
Middle Name:SUN
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 HAMPSHIRE PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-1251
Mailing Address - Country:US
Mailing Address - Phone:407-292-6992
Mailing Address - Fax:
Practice Address - Street 1:340 S STATE ROAD 434 STE 1034
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3861
Practice Address - Country:US
Practice Address - Phone:407-788-8718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0026250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist