Provider Demographics
NPI:1245527340
Name:KIM, SANG YUP (DPM)
Entity type:Individual
Prefix:DR
First Name:SANG
Middle Name:YUP
Last Name:KIM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5451 LA PALMA AVE STE 26
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1730
Mailing Address - Country:US
Mailing Address - Phone:714-735-8588
Mailing Address - Fax:562-249-8443
Practice Address - Street 1:5451 LA PALMA AVE STE 26
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1730
Practice Address - Country:US
Practice Address - Phone:714-735-8588
Practice Address - Fax:562-249-8443
Is Sole Proprietor?:No
Enumeration Date:2011-07-09
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5105213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery