Provider Demographics
NPI:1750441929
Name:KIM, LAWRENCE YOUNG (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:YOUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 NE 151ST AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-3657
Mailing Address - Country:US
Mailing Address - Phone:360-949-7042
Mailing Address - Fax:
Practice Address - Street 1:1309 NE 151ST AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-3657
Practice Address - Country:US
Practice Address - Phone:360-949-7042
Practice Address - Fax:360-949-7042
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2013-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000296312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry