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General NPI Number Information
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NPI Number | 1356674519
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Entity Type | Individual
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Provider Name | KIM SAMUEL YOUNG D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/04/2009
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 6349 US HWY 550
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City | CUBA
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State | NM
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Zip | 87013-0638
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Country | US
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Telephone | 575-289-3291
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Fax | 505-722-7470
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Provider Business Mailing Address
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Address Line | PO BOX 2267
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City | SANTA FE
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State | NM
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Zip | 87504-2267
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Country | US
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Telephone | 59-825-5655
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Fax | 505-992-4990
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4023
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A-1267-04
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0031167
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License Number State | CO
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