Provider Demographics
NPI:1568494367
Name:KIM, SANG YOU (MD)
Entity Type:Individual
Prefix:DR
First Name:SANG
Middle Name:YOU
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 1:14273 RUBY GLEN CT
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5915
Mailing Address - Country:US
Mailing Address - Phone:714-351-1418
Mailing Address - Fax:
Practice Address - Street 1:14273 RUBY GLEN CT
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5915
Practice Address - Country:US
Practice Address - Phone:714-351-1418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41877208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41877GMedicare ID - Type UnspecifiedNHIC MEDICARE
CAC01563Medicare UPIN