Provider Demographics
NPI:1558505321
Name:KIM, DAVID DAE-YOUNG (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DAE-YOUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAE-YOUNG
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:19950 RINALDI ST, SUITE 310
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326
Mailing Address - Country:US
Mailing Address - Phone:818-271-2500
Mailing Address - Fax:818-271-2501
Practice Address - Street 1:19950 RINALDI ST, SUITE 310
Practice Address - Street 2:
Practice Address - City:PORT RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326
Practice Address - Country:US
Practice Address - Phone:818-271-2500
Practice Address - Fax:818-271-2501
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91389207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902108293Medicaid
CA1558505321Medicaid
CA1558505321Medicaid
CA1902108293Medicaid