Healthcare Provider Details

I. General information

NPI: 1184069296
Provider Name (Legal Business Name): YOUNGHO PAUL KIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 CAMPUS POINT DR CPC 310
SAN DIEGO CA
92121-1518
US

IV. Provider business mailing address

10010 CAMPUS POINT DR CPC 310
SAN DIEGO CA
92121-1518
US

V. Phone/Fax

Practice location:
  • Phone: 858-678-6574
  • Fax: 858-678-6571
Mailing address:
  • Phone: 858-678-6574
  • Fax: 858-678-6571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number285216
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberA159497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: