Provider Demographics
NPI:1982632790
Name:KIM, YUNG SO (MD)
Entity Type:Individual
Prefix:
First Name:YUNG
Middle Name:SO
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:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-934-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL265762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01356292OtherMISSISSIPPI MEDICAID
AL009994205Medicaid
AL05152829OtherBLUE CROSS
AL051528291OtherBLUE CROSS
AL051528290OtherBLUE CROSS
AL009994215Medicaid
AL009994195Medicaid
AL010033CB54133OtherSECTION 1011
AL051528288OtherBLUE CROSS
AL051528288OtherBLUE CROSS
AL010033CB54133OtherSECTION 1011