Provider Demographics
NPI:1659577286
Name:KIM, KEUN-YOUNG ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:KEUN-YOUNG
Middle Name:ANTHONY
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MDINC
Mailing Address - Street 1:26732 CROWN VALLEY PARKWAY
Mailing Address - Street 2:SUITE #541
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-388-7190
Mailing Address - Fax:
Practice Address - Street 1:26732 CROWN VALLEY PARKWAY
Practice Address - Street 2:SUITE #541
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-388-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79340207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery