Provider Demographics
NPI:1730517723
Name:KIM, BYOUNG
Entity type:Individual
Prefix:MR
First Name:BYOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 E A ST STE 100B
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4102
Mailing Address - Country:US
Mailing Address - Phone:918-995-1100
Mailing Address - Fax:800-930-1401
Practice Address - Street 1:531 E A ST STE 100B
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-4102
Practice Address - Country:US
Practice Address - Phone:918-995-1100
Practice Address - Fax:800-930-1401
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000057171100000X
OK171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist