Provider Demographics
NPI:1528055456
Name:KIM, YANG (MD)
Entity type:Individual
Prefix:
First Name:YANG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S VIRGIL AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1449
Mailing Address - Country:US
Mailing Address - Phone:213-388-7828
Mailing Address - Fax:213-388-7838
Practice Address - Street 1:500 S VIRGIL AVE # 2047A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020
Practice Address - Country:US
Practice Address - Phone:213-388-7828
Practice Address - Fax:213-388-7838
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1900952080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01605150Medicaid
NY520381Medicare ID - Type Unspecified
NYG05629Medicare UPIN