Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | A79002 | CA |
N | 207PE0004X | Emergency Medical Services | A79002 | CA |
N | 207PP0204X | Pediatric Emergency Physician | A79002 | CA |
NPI | 1225353022 |
---|---|
Provider Name | Dr. Sonya Young Kim |
First Address | San Carlos, CA 94070-1758 |
Second Address | San Carlos, CA 94070-1758 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2010 |
Last Update Date | 09/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A79002 | CA STATE MEDICAL LICENSE (01) | CA |
FK1815731 | FEDERAL DEA (01) | |
MD 12795 | HI STATE MEDICAL LICENSE (01) | HI |