Provider Demographics
NPI:1700207941
Name:KIM, YOUNG (MD,PHD)
Entity type:Individual
Prefix:
First Name:YOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20126 STANTON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5270
Mailing Address - Country:US
Mailing Address - Phone:510-537-3556
Mailing Address - Fax:
Practice Address - Street 1:20126 STANTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5270
Practice Address - Country:US
Practice Address - Phone:510-537-3556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA127211207R00000X, 207RC0001X, 207RC0000X
MO2020004739207RC0000X
AZ72768207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology