Provider Demographics
NPI:1962421529
Name:KIM, YOON HOON (MD)
Entity type:Individual
Prefix:DR
First Name:YOON
Middle Name:HOON
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 1:629 N MAIN ST STE C3
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-1410
Mailing Address - Country:US
Mailing Address - Phone:951-738-2400
Mailing Address - Fax:951-340-3566
Practice Address - Street 1:629 N MAIN ST STE C3
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-1410
Practice Address - Country:US
Practice Address - Phone:951-738-2400
Practice Address - Fax:951-340-3566
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0436622084P0800X
CAC516752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0497184Medicare ID - Type Unspecified