Provider Demographics
NPI:1861018129
Name:KIM, KI YU (MD)
Entity type:Individual
Prefix:
First Name:KI YU
Middle Name:
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 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:667-306-7130
Mailing Address - Fax:
Practice Address - Street 1:3501 JOHN SIMMONS ST STE A201
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:MD
Practice Address - Zip Code:21704-7964
Practice Address - Country:US
Practice Address - Phone:240-699-1050
Practice Address - Fax:410-367-2353
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351046236207Q00000X
MDD0101651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine