Provider Demographics
NPI:1134216831
Name:KIM, YOUNG IL (MD)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:IL
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12121 RICHMOND AV
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082
Mailing Address - Country:US
Mailing Address - Phone:713-270-7200
Mailing Address - Fax:281-584-9240
Practice Address - Street 1:12121 RICHMOND AV
Practice Address - Street 2:SUITE 101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082
Practice Address - Country:US
Practice Address - Phone:713-270-7200
Practice Address - Fax:281-584-9240
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE4876207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0525751OtherAETNA
TX44358OtherAMERIGROUP
74212020277082OtherTRICARE CHAMPUS
TX09837102Medicaid
C17865Medicare UPIN
TX00MN90Medicare PIN