Provider Demographics
NPI:1184601916
Name:KIM, YONG W (MD)
Entity type:Individual
Prefix:DR
First Name:YONG
Middle Name:W
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:YON
Other - Middle Name:W
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 950
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-0950
Mailing Address - Country:US
Mailing Address - Phone:740-654-4427
Mailing Address - Fax:740-687-2011
Practice Address - Street 1:1147 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4056
Practice Address - Country:US
Practice Address - Phone:740-654-4427
Practice Address - Fax:740-687-2011
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064371207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0897383Medicaid
OH0728113Medicare ID - Type Unspecified
OHD73149Medicare UPIN