Healthcare Provider Details

I. General information

NPI: 1841606076
Provider Name (Legal Business Name): YURI KIM D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 04/26/2020
Certification Date: 04/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONGRESS ST STE 350
PASADENA CA
91105-3020
US

IV. Provider business mailing address

235 S SAN PEDRO ST APT 620
LOS ANGELES CA
90012-3584
US

V. Phone/Fax

Practice location:
  • Phone: 626-509-9449
  • Fax: 309-305-3542
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number20A15354
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number20A15354
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: