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NPI Code Detail

MEDICARE: DR. DAVID SHIN YOUNG KIM M.D.

MEDICARE: DR. DAVID SHIN YOUNG KIM M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207LP2900XPain Medicine (Anesthesiology) PhysicianA90036CA

General Provider Information

NPI Number : 1558577353
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID SHIN YOUNG KIM M.D.
Provider Business Mailing Address
First Line : 11201 BENTON ST
Second Line :
City : LOMA LINDA
State : CA
Zip : 92357-5153
Country : US
Telephone Number : 909-825-7084
Fax Number :
Provider Business Practice Location Address
First Line : 11201 BENTON ST
Second Line :
City : LOMA LINDA
State : CA
Zip : 92357-5153
Country : US
Telephone Number : 909-825-7084
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2007
Last Update Date : 05/26/2026

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