Provider Demographics
NPI:1366475782
Name:KIM, MIRIAM YUN-MI (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:YUN-MI
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9325 UPLAND LN N
Mailing Address - Street 2:STE 205
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4474
Mailing Address - Country:US
Mailing Address - Phone:763-542-8888
Mailing Address - Fax:
Practice Address - Street 1:9325 UPLAND LN N STE 205
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4474
Practice Address - Country:US
Practice Address - Phone:763-542-8888
Practice Address - Fax:763-542-8899
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48923-020207T00000X
ND8598207T00000X
MN44450207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH30308Medicare UPIN