Provider Demographics
NPI:1679510994
Name:KIM, YONG K (MD)
Entity Type:Individual
Prefix:DR
First Name:YONG
Middle Name:K
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1403 FOULK RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2788
Mailing Address - Country:US
Mailing Address - Phone:302-477-2506
Mailing Address - Fax:302-477-2507
Practice Address - Street 1:1403 FOULK RD
Practice Address - Street 2:SUITE 108
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2788
Practice Address - Country:US
Practice Address - Phone:302-477-2506
Practice Address - Fax:302-477-2507
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10001805208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000056801Medicaid
DE0000056801Medicaid
DEC34030Medicare UPIN