Provider Demographics
NPI:1063483667
Name:YU, KIM KIA (MD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:KIA
Last Name:YU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:451 W LINCOLN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2912
Mailing Address - Country:US
Mailing Address - Phone:714-503-6550
Mailing Address - Fax:714-409-3075
Practice Address - Street 1:19742 MACARTHUR BLVD STE 250
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2488
Practice Address - Country:US
Practice Address - Phone:714-503-6550
Practice Address - Fax:714-309-4075
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301070014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080H232630OtherBCN GROUP
MI4397890-10Medicaid
MI080H232630OtherBCBS GROUP
MI0808290401OtherBCBS BCN
MI1063483667Medicaid
MI080H232630OtherBCBS GROUP
MI0808290401OtherBCBS BCN
MI0N50880Medicare PIN