Provider Demographics
NPI:1063430593
Name:KIM, YOUNG I (MD)
Entity type:Individual
Prefix:MR
First Name:YOUNG
Middle Name:I
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:833 S IOWA ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533
Mailing Address - Country:US
Mailing Address - Phone:608-935-9335
Mailing Address - Fax:608-935-2500
Practice Address - Street 1:833 S IOWA ST
Practice Address - Street 2:SUITE 106
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533
Practice Address - Country:US
Practice Address - Phone:608-935-9335
Practice Address - Fax:608-935-2500
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18236208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31090600Medicaid
WI27011Medicare ID - Type Unspecified
B84981Medicare UPIN