Healthcare Provider Details

I. General information

NPI: 1225353022
Provider Name (Legal Business Name): SONYA YOUNG KIM M.D., MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SONYA YOUNG KIM M.D.

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DEVONSHIRE BLVD APT 8
SAN CARLOS CA
94070-1758
US

IV. Provider business mailing address

1 DEVONSHIRE BLVD APT 8
SAN CARLOS CA
94070-1758
US

V. Phone/Fax

Practice location:
  • Phone: 415-314-1005
  • Fax: 888-959-8346
Mailing address:
  • Phone: 415-314-1005
  • Fax: 888-959-8346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberA79002
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberA79002
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA79002
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberA79002
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberA79002
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberA79002
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License NumberA79002
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: