Provider Demographics
NPI:1760475446
Name:KIM, HYO H (MD)
Entity Type:Individual
Prefix:
First Name:HYO
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 NORTH RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-3301
Mailing Address - Country:US
Mailing Address - Phone:330-989-5010
Mailing Address - Fax:330-989-5019
Practice Address - Street 1:2022 NORTH RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-3301
Practice Address - Country:US
Practice Address - Phone:330-989-5010
Practice Address - Fax:330-989-5019
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-6977-K174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0711537Medicaid
OHB48089Medicare UPIN
OH0616124Medicare PIN