Provider Demographics
NPI:1922009125
Name:KIM, YOUNG HWAN (MD)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:HWAN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:26908 DETROIT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2398
Mailing Address - Country:US
Mailing Address - Phone:440-617-1823
Mailing Address - Fax:440-617-0884
Practice Address - Street 1:1 EAGLE VALLEY CT
Practice Address - Street 2:SUITE 101
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2982
Practice Address - Country:US
Practice Address - Phone:440-746-1055
Practice Address - Fax:440-746-1052
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2009-03-17
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Provider Licenses
StateLicense IDTaxonomies
OH35034174207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00381216OtherRR MEDICARE
OH0227570Medicaid
OHB77491Medicare UPIN
OH4120765Medicare PIN