Provider Demographics
NPI:1104925015
Name:KIM, YOUNG SUN (MD)
Entity type:Individual
Prefix:
First Name:YOUNG
Middle Name:SUN
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YOUNG
Other - Middle Name:S
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1245 WILSHIRE BLVD STE 715
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4807
Mailing Address - Country:US
Mailing Address - Phone:213-482-3990
Mailing Address - Fax:213-482-3992
Practice Address - Street 1:2405 W 8TH STREET #201
Practice Address - Street 2:YOUNG S KIM MD
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-5016
Practice Address - Country:US
Practice Address - Phone:213-383-3994
Practice Address - Fax:213-383-8491
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31584207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000A315840Medicaid
CAA31584Medicare ID - Type Unspecified