Provider Demographics
NPI:1124549134
Name:KIM, YOUNGSUN (DPT, OCS, SCS, MTC)
Entity type:Individual
Prefix:DR
First Name:YOUNGSUN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DPT, OCS, SCS, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11717 SORRENTO VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1004
Mailing Address - Country:US
Mailing Address - Phone:858-847-2025
Mailing Address - Fax:
Practice Address - Street 1:11717 SORRENTO VALLEY RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1004
Practice Address - Country:US
Practice Address - Phone:858-847-2025
Practice Address - Fax:844-270-6457
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2024-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist