Individual provider Active NPI

Lydia Kim

  • Pediatrics Physician
  • Baltimore, MD
National Provider Identifier
1043586548
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D80188 Issued in MD
Practice address
200 N Wolfe St Ste 3075
Baltimore, MD 21287
Phone
(410) 955-2035
Fax
(410) 955-1030
NPI assigned
Mar 28, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X D80188 MD Primary

Addresses

Primary practice location

200 N Wolfe St Ste 3075
Baltimore, MD 21287

Mailing address

9910 Franklin Square Dr # 2110
Baltimore, MD 21236-4902
Phone (410) 933-6421

Other practice location 1

22 S Greene St
Baltimore, MD 21201-1544
Phone (410) 328-6662

Other identifiers 1

IdentifierTypeStateIssuer
D80188OtherMDLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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 1

Enrollment IDStateProvider typePAC IDDetails
I20190907000090 MD Practitioner - Pediatric Medicine 7315283231 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Johns Hopkins University CurrentSince Aug 1, 2019 Accepting new patients
Johns Hopkins University Current Accepting new patients
Johns Hopkins University CurrentSince Aug 1, 2019 Accepting new patients

Locations

200 N Wolfe St
Ste 3075
Baltimore, MD 21287
Phone (410) 955-2035

600 N Wolfe St
Baltimore, MD 21287

601 N Caroline St
Baltimore, MD 21287
Phone (410) 955-5080

5755 Cedar Ln
Columbia, MD 21044
Phone (410) 381-7171

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1332892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1043586548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9910 FRANKLIN SQUARE DR # 2110",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212364902",
            "telephone_number": "410-933-6421",
            "fax_number": "410-955-1030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N WOLFE ST STE 3075",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21287",
            "telephone_number": "410-955-2035",
            "fax_number": "410-955-1030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22 S Greene St",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212011544",
            "country_code": "US",
            "telephone_number": "410-328-6662",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "LYDIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-28",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D80188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "D80188",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.