Provider Demographics
NPI:1609854231
Name:YANG, KIM S (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:S
Last Name:YANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S SANTA ANITA ST
Mailing Address - Street 2:STE 320
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1154
Mailing Address - Country:US
Mailing Address - Phone:626-458-0181
Mailing Address - Fax:626-458-0183
Practice Address - Street 1:207 S SANTA ANITA ST
Practice Address - Street 2:STE 320
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1154
Practice Address - Country:US
Practice Address - Phone:626-458-0181
Practice Address - Fax:626-458-0183
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA408242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A408240Medicaid
A40824Medicare ID - Type Unspecified
WA40824AMedicare PIN
A13953Medicare UPIN