Provider Demographics
NPI:1790721405
Name:KIM, YUSHIK (MD)
Entity Type:Individual
Prefix:
First Name:YUSHIK
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUKE
Other - Middle Name:Y
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5333 MCAULEY DR
Mailing Address - Street 2:SUITE R-4115
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1014
Mailing Address - Country:US
Mailing Address - Phone:734-434-2477
Mailing Address - Fax:734-572-1007
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:SUITE R-4115
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1014
Practice Address - Country:US
Practice Address - Phone:734-434-2477
Practice Address - Fax:734-572-1007
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1528208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
2508140171OtherBLE CROSS/BLUE SHIED
MILK037469OtherSTATE
2508140171OtherBLE CROSS/BLUE SHIED
B44393Medicare UPIN