Provider Demographics
NPI:1962469866
Name:KIM, YONG S (MD)
Entity Type:Individual
Prefix:DR
First Name:YONG
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8900 MARQUETTE DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1579
Mailing Address - Country:US
Mailing Address - Phone:734-283-4616
Mailing Address - Fax:734-283-5430
Practice Address - Street 1:15350 TRENTON RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2027
Practice Address - Country:US
Practice Address - Phone:734-283-4616
Practice Address - Fax:734-283-5430
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI4301031868208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1031093Medicaid
MI1031093Medicaid