Active NPI
Jae Hun Kim, PA
- Physician Assistant
- Las Vegas, NV
National Provider Identifier
1063055481
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA2230
- Practice address
- 540 N Nellis Blvd
Las Vegas, NV 89110-5368 - Phone
- (702) 877-5199
- NPI assigned
- Oct 18, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA2230 | NV | Primary |
Addresses
Primary practice location
540 N Nellis Blvd
Las Vegas, NV 89110-5368
Mailing address
PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 877-5199
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4475 S Eastern Ave
Las Vegas, NV 89119-7826
Phone (702) 579-3253
4750 W Oakey Blvd
Las Vegas, NV 89102-1535
Phone (702) 579-3253
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA2230 | NV | MD | Physician Assistant |
Interoperability endpoints
- jkim120947@westdirect.optum.com
Organizations & group practices 2
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.
-
dba Southwest Medical
- Internal Medicine Physician
- Las Vegas, NV
- NPI 1790329407
-
- Internal Medicine Physician
- Las Vegas, NV
- NPI 1659346005
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578441600000",
"number": "1063055481",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 35380",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891335380",
"telephone_number": "702-877-5199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "540 N NELLIS BLVD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891105368",
"telephone_number": "702-877-5199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JAE HUN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-18",
"last_updated": "2020-01-08",
"certification_date": "2020-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NV",
"license": "PA2230",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2020; 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.