Healthcare Provider Details

I. General information

NPI: 1306846167
Provider Name (Legal Business Name): YOUNG C KIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18697 BAGLEY ROAD
MIDDLEBURG HEIGHTS OH
44130-3417
US

IV. Provider business mailing address

5655 HUDSON DRIVE SUITE 210
HUDSON OH
44236-4451
US

V. Phone/Fax

Practice location:
  • Phone: 440-816-8770
  • Fax: 440-816-8806
Mailing address:
  • Phone: 330-655-3800
  • Fax: 330-655-3828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35045848
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.045848
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: