Provider Demographics
NPI:1629233234
Name:KIM, YOUNGHOON (PT,DPT,OCS,CSCS)
Entity Type:Individual
Prefix:DR
First Name:YOUNGHOON
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PT,DPT,OCS,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5203
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539
Mailing Address - Country:US
Mailing Address - Phone:661-942-2202
Mailing Address - Fax:661-942-2203
Practice Address - Street 1:42301 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-7000
Practice Address - Country:US
Practice Address - Phone:661-942-2202
Practice Address - Fax:661-942-2203
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA274062251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAS087ZOtherPROVIDER TRANSACTION ACCESS NUMBER