Provider Demographics
NPI:1427143197
Name:KIM, HO YOUNG (MD)
Entity type:Individual
Prefix:
First Name:HO
Middle Name:YOUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1729
Mailing Address - Country:US
Mailing Address - Phone:601-545-8700
Mailing Address - Fax:601-450-2493
Practice Address - Street 1:598 W 11TH AVE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:MS
Practice Address - Zip Code:39455-2350
Practice Address - Country:US
Practice Address - Phone:601-796-4215
Practice Address - Fax:601-796-9437
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE28436207Q00000X
MS21040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04501009Medicaid
D15779Medicare UPIN
IL036067027Medicaid