Kim Kory Young, M.HTECHICIAN/L.L.MSW

Primary specialty

Other TechnicianTaxonomy code 247200000X

License

L148347 Issued in MI

Practice address

116 N Johnson St
Pontiac, MI 48341-1330

Phone

(248) 613-4098

Fax

(248) 622-4081

NPI assigned

Sep 1, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Kim K Young Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Johnson Estate LLC

  dba Jet LLC

  • Assisted Living Facility (Mental Illness)
  • Pontiac, MI
  • NPI 1942893250
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586476800000",
    "number": "1083160790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 N JOHNSON ST",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "48341",
            "telephone_number": "248-613-4098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 N JOHNSON ST",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483411330",
            "telephone_number": "248-613-4098",
            "fax_number": "248-622-4081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "KIM",
        "middle_name": "KORY",
        "name_prefix": "Ms.",
        "credential": "M.HTECHICIAN/L.L.MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-01",
        "last_updated": "2020-04-10",
        "certification_date": "2020-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MI",
            "license": "1-04781",
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": "MI",
            "license": "L148347",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS BUREAU OF HEALTH CARE SERVICES",
            "identifier": "L148347",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "YOUNG",
            "middle_name": "K",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dina Yermakhanova, MD
• Rachel Yoder, DC
• Rachel Yoder, MSN, CRNA
• Yamuna Yoganathan, MD
• Bryce Young, DO
• Kyisha Young
• Terri Young
• Kristin Yousif
• Zaid Yousif, PHARMD
• Abdulrahman M Zahurullah, MD

• Other Technician in Pontiac, MI
• Providers in Pontiac, MI by specialty
• Other Technician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.