Provider Demographics
NPI:1407864010
Name:KIM, MYOUNG S (MD)
Entity Type:Individual
Prefix:DR
First Name:MYOUNG
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:211 EASY ST STE 121
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3129
Mailing Address - Country:US
Mailing Address - Phone:724-439-6300
Mailing Address - Fax:724-439-5619
Practice Address - Street 1:211 EASY ST STE 121
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3129
Practice Address - Country:US
Practice Address - Phone:724-439-6300
Practice Address - Fax:724-439-5619
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD03657L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA141348Medicaid
C31566Medicare UPIN
PA141348Medicaid