Provider Demographics
NPI:1336171990
Name:KIM, MYUNG S (MD)
Entity Type:Individual
Prefix:DR
First Name:MYUNG
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MYUNG
Other - Middle Name:IL
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22550 SAVI RANCH PKWY
Mailing Address - Street 2:YORBA LINDA MEDICAL OFFICES
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-4670
Mailing Address - Country:US
Mailing Address - Phone:714-685-3520
Mailing Address - Fax:
Practice Address - Street 1:22550 SAVI RANCH PARKWAY
Practice Address - Street 2:YORBA LINDA MEDICAL OFFICES
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887
Practice Address - Country:US
Practice Address - Phone:714-685-3520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79970207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00179045OtherRAILROAD MEDICARE
CAW11675OtherGROUP MEDICARE PIN
CA1356390009OtherGROUP NPI
CA00A799700Medicaid
CA00A799700197OtherCAL OPTIMA
CAGR0016910OtherGROUP MEDICAID PIN
CA00A799700OtherBLUE SHIELD
CACE1617OtherGROUP RAILROAD MEDICARE
CA00A799700197OtherCAL OPTIMA
CA1356390009OtherGROUP NPI