Provider Demographics
NPI:1114716214
Name:KIM, YOUNGSIL (MD)
Entity type:Individual
Prefix:
First Name:YOUNGSIL
Middle Name:
Last Name:KIM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NEAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:MARION CENTER
Mailing Address - State:PA
Mailing Address - Zip Code:15759
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 NEAL AVENUE
Practice Address - Street 2:
Practice Address - City:MARION CENTER
Practice Address - State:PA
Practice Address - Zip Code:15759
Practice Address - Country:US
Practice Address - Phone:724-397-5571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program