Healthcare Provider Details

I. General information

NPI: 1053448373
Provider Name (Legal Business Name): YOUNG RAE KIM MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 W ORANGE AVE STE 407
ANAHEIM CA
92804
US

IV. Provider business mailing address

3010 W ORANGE AVE STE 407
ANAHEIM CA
92804-3173
US

V. Phone/Fax

Practice location:
  • Phone: 714-484-3781
  • Fax: 714-484-3852
Mailing address:
  • Phone: 714-484-3781
  • Fax: 714-484-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA52615
License Number StateCA

VIII. Authorized Official

Name: YOUNG RAE KIM
Title or Position: PRESIDENT
Credential: MEDICAL DIRECTOR
Phone: 714-484-3781