Provider Demographics
NPI:1457445512
Name:KIM, YOUNG HEE (MD)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:HEE
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 1:50 WEST UTICA ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126
Mailing Address - Country:US
Mailing Address - Phone:315-342-2313
Mailing Address - Fax:315-342-3087
Practice Address - Street 1:50 WEST UTICA ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126
Practice Address - Country:US
Practice Address - Phone:315-342-2313
Practice Address - Fax:315-342-3087
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149450208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00938Medicare UPIN
NYRA6925Medicare ID - Type Unspecified
NYBA0581Medicare ID - Type Unspecified