Provider Demographics
NPI:1588005672
Name:YUN W KIM, MD, PA
Entity Type:Organization
Organization Name:YUN W KIM, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-472-3161
Mailing Address - Street 1:11207 N LAMAR BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-3056
Mailing Address - Country:US
Mailing Address - Phone:512-649-2195
Mailing Address - Fax:512-814-0726
Practice Address - Street 1:11207 N LAMAR BLVD STE B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-3056
Practice Address - Country:US
Practice Address - Phone:512-649-2195
Practice Address - Fax:512-814-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX295447Medicare PIN