Provider Demographics
NPI:1184069296
Name:KIM, YOUNGHO PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:YOUNGHO
Middle Name:PAUL
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10010 CAMPUS POINT DR
Mailing Address - Street 2:CPC 310
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1518
Mailing Address - Country:US
Mailing Address - Phone:858-678-6574
Mailing Address - Fax:858-678-6571
Practice Address - Street 1:10010 CAMPUS POINT DR
Practice Address - Street 2:CPC 310
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1518
Practice Address - Country:US
Practice Address - Phone:858-678-6574
Practice Address - Fax:858-678-6571
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY285216207QH0002X
NY390200000X
CAA159497207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty