Provider Demographics
NPI:1104563675
Name:KIM, YONG CHAN (MD)
Entity type:Individual
Prefix:MR
First Name:YONG CHAN
Middle Name:
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 1:1330 EAST 6TH STREET, SUITE 105
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596
Mailing Address - Country:US
Mailing Address - Phone:956-296-7722
Mailing Address - Fax:
Practice Address - Street 1:1330 EAST 6TH STREET, SUITE 105
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596
Practice Address - Country:US
Practice Address - Phone:956-296-7722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2023-02-03
Deactivation Date:2023-01-23
Deactivation Code:
Reactivation Date:2023-02-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program