Provider Demographics
NPI:1093502148
Name:KYK MEDICAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:KYK MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KI-YOON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-566-8931
Mailing Address - Street 1:417 S ASSOCIATED RD # 285
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5802
Mailing Address - Country:US
Mailing Address - Phone:201-566-8931
Mailing Address - Fax:832-406-3968
Practice Address - Street 1:417 S ASSOCIATED RD # 285
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5802
Practice Address - Country:US
Practice Address - Phone:201-566-8931
Practice Address - Fax:832-406-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty