Provider Demographics
NPI:1518595784
Name:KIM, JIN YOUNG (MD, PHD)
Entity Type:Individual
Prefix:
First Name:JIN YOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:LEO
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:175 N MEDICAL DRIVE EAST 5TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-587-8338
Mailing Address - Fax:
Practice Address - Street 1:175 N MEDICAL DRIVE EAST 5TH FLOOR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-587-8338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12985856-1205207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery