Provider Demographics
NPI:1679576094
Name:KIM, YONG SIK (MD)
Entity Type:Individual
Prefix:PROF
First Name:YONG
Middle Name:SIK
Last Name:KIM
Suffix:
Gender:M
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 1:8830 LONG POINT RD
Mailing Address - Street 2:105
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-3040
Mailing Address - Country:US
Mailing Address - Phone:713-932-0240
Mailing Address - Fax:713-932-0250
Practice Address - Street 1:8830 LONG POINT RD
Practice Address - Street 2:105
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-3040
Practice Address - Country:US
Practice Address - Phone:713-932-0240
Practice Address - Fax:713-932-0250
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S6145OtherBCBSTX
TXI42588OtherUPIN
TX176400301Medicaid
TXI42588OtherUPIN
TX176400301Medicaid
TX8S6145OtherBCBSTX