Provider Demographics
NPI:1457630055
Name:KIM, SEAN YOUNGJIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:YOUNGJIN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:600 N GARFIELD AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1170
Mailing Address - Country:US
Mailing Address - Phone:626-573-8282
Mailing Address - Fax:626-573-8338
Practice Address - Street 1:600 N GARFIELD AVE STE 210
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1170
Practice Address - Country:US
Practice Address - Phone:626-573-8282
Practice Address - Fax:626-573-8338
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123580208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery