Provider Demographics
NPI:1912086331
Name:KIM, YUNGAE KRISTY (MD)
Entity Type:Individual
Prefix:DR
First Name:YUNGAE
Middle Name:KRISTY
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTY
Other - Middle Name:YUNGAE
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3544 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE #202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3500
Mailing Address - Country:US
Mailing Address - Phone:323-732-7111
Mailing Address - Fax:323-732-9028
Practice Address - Street 1:3435 WILSHIRE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1906
Practice Address - Country:US
Practice Address - Phone:213-384-3435
Practice Address - Fax:213-384-5559
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51774207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG51774Medicare ID - Type UnspecifiedLICENSE NUMBER
CAA93106Medicare UPIN