Provider Demographics
NPI:1649236522
Name:KIM, YOUNG MIN (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:MIN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3724 LONE TREE WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509
Mailing Address - Country:US
Mailing Address - Phone:925-778-0700
Mailing Address - Fax:925-778-7400
Practice Address - Street 1:3724 LONE TREE WAY
Practice Address - Street 2:SUITE A
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509
Practice Address - Country:US
Practice Address - Phone:925-778-0700
Practice Address - Fax:925-778-7400
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51136207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C511360Medicaid
BK 3156189OtherDEA NO
F132615Medicare UPIN