Provider Demographics
NPI:1689764144
Name:KIM, YOUNGKI (M)
Entity Type:Individual
Prefix:
First Name:YOUNGKI
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE MMC 491
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-6777
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE ST SE
Practice Address - Street 2:PWB 4TH FLOOR, ROOM 4-100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0356
Practice Address - Country:US
Practice Address - Phone:612-626-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22048208000000X, 2080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN053926OtherFAIRVIEW
OH2104458Medicaid
768197OtherARAZ
MN3107051OtherMEDICA-CHOICE
MN3107051OtherMEDICA-PRIMARY
MN2T291KIOtherBCBS
MNHP21987OtherHEALTH PARTNERS
IA0990457Medicaid
MN1012191OtherPREFERRED ONE
ND10387Medicaid
WI30200800Medicaid
MT0012087Medicaid
KY64421308Medicaid
A063OtherCHAMPUS/TRIWEST
MN101068OtherU CARE
MN685883000Medicaid
SD7777470Medicaid
MN053926OtherFAIRVIEW
MN3107051OtherMEDICA-CHOICE