MEDICARE: KIM YU MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301070014	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0808290401	OTHER	MI	BCBC BCN
2	129807	OTHER	MI	CARE CHOICES
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	080H232630	OTHER	MI	BCBS BCN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	7949343	OTHER	MI	AETNA
7	C7622	OTHER	MI	MCARE
8	H31767	OTHER	MI	HAP
9	153351	OTHER	MI	GREAT LAKES

General Provider Information

NPI Number	:	1972541332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIM YU MD PC

Provider Business Mailing Address
First Line	:	8555 N SILVERY LN
Second Line	:	SUITE 402
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-1379
Country	:	US
Telephone Number	:	313-561-0550
Fax Number	:	313-561-3646

Provider Business Practice Location Address
First Line	:	8555 N SILVERY LN
Second Line	:	SUITE 402
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-1379
Country	:	US
Telephone Number	:	313-561-0550
Fax Number	:	313-561-3646

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. KIM YU
Credential	:	MD
Telephone Number	:	313-651-0550

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	07/23/2009

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Directions to “KIM YU MD PC ” Practice Location

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