Eda Moonhi Kim, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

73015 Issued in GA

Practice address

1600 N Brown Rd
Lawrenceville, GA 30043-8141

Phone

(678) 710-6872

NPI assigned

Jan 19, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, GA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Family Practice

Education

University of California, San Diego School of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• AL HMO D-SNP
• devoted network organization-14bfd35d-d818-4696-813b-340339e464ef
• AL HMO
• devoted network organization-25ba88d3-d0a6-4213-84f1-eef6f2b59f68
• devoted network organization-d5084670-562f-408b-b100-22a1a4ef4d82

Interoperability endpoints

• Direct secure messaging: eda.kim.3@23284.direct.athenahealth.com

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.

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Galileo Medical Group Ga, P.C.

  • Family Medicine Physician
  • New York, NY
  • NPI 1245920305

  GA

  Medicare reassignment NPD
• Marcus Zachary, D.O., P.C.

  • Family Medicine Physician
  • Fresno, CA
  • NPI 1710592621
  NPD

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

{
    "created_epoch": "1421625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736294400000",
    "number": "1013306752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 N BROWN RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300438141",
            "telephone_number": "678-710-6872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 N BROWN RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300438141",
            "telephone_number": "678-710-6872"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "632 Broadway Ph",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100122614",
            "country_code": "US",
            "telephone_number": "800-731-4254",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "EDA",
        "middle_name": "MOONHI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-19",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A66699",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "73015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kidspeech, Inc.
• Ramona Kilkenny-Lester, NP
• Austin Yung Kyo Kim
• Bernard Matthew Kim, MD
• Christopher Joon Ki Kim, MD, PHARMD
• Edmund Sung Joon Kim, M.D.
• Eugene Kim, D.M.D.
• Ga U Kim
• Gina Kim, NP-C
• Han N Kim, NP

• Family Medicine Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.