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General NPI Number Information
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NPI Number | 1063982981
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Entity Type | Individual
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Provider Name | YEON KIM PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/04/2018
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 28 GEARY ST STE 650
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City | SAN FRANCISCO
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State | CA
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Zip | 94108-5700
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Country | US
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Telephone | 628-215-1120
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Fax |
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Provider Business Mailing Address
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Address Line | 720 KNOLLWOOD LN
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City | SAN DIMAS
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State | CA
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Zip | 91773-3617
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MA060272
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA060272
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License Number State | PA
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