Provider Demographics
NPI:1134213234
Name:KIM, YOUNG H (MD)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3557A 77TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-4506
Mailing Address - Country:US
Mailing Address - Phone:718-651-7474
Mailing Address - Fax:718-899-4090
Practice Address - Street 1:3557A 77TH ST
Practice Address - Street 2:A
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-4506
Practice Address - Country:US
Practice Address - Phone:718-651-7474
Practice Address - Fax:718-899-4090
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0030838OtherGHI
NY01030088Medicaid
NY01030088Medicaid
NY02E791Medicare PIN
NYE39538Medicare UPIN