Provider Demographics
NPI:1477695393
Name:KIM, YUNG TAE (MD)
Entity Type:Individual
Prefix:MR
First Name:YUNG TAE
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 W ORANGE AVE
Mailing Address - Street 2:#108
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3169
Mailing Address - Country:US
Mailing Address - Phone:714-527-7731
Mailing Address - Fax:714-527-7911
Practice Address - Street 1:3010 W ORANGE AVE
Practice Address - Street 2:#108
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3169
Practice Address - Country:US
Practice Address - Phone:714-527-7731
Practice Address - Fax:714-527-7911
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34417207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A344170Medicaid
B50254Medicare UPIN
CA00A344170Medicaid