Individual provider Active NPI

Carl Dongseong Kim, MD

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1063152114
Registry record updated Sep 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD490512 Issued in PA
Practice address
800 Spruce St
Philadelphia, PA 19107-6192
Phone
(215) 829-3000
NPI assigned
Mar 29, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD490512 PA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

800 Spruce St
Philadelphia, PA 19107-6192

Mailing address

800 Spruce St
Philadelphia, PA 19107-6192
Phone (215) 829-3000

Other practice location 1

2230 Cottman Ave
Philadelphia, PA 19149-1230
Phone (215) 685-0603

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20250912001314 PA Practitioner - Internal Medicine 4284145376 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
City of PhiladelphiaGroup PAC ID 6305758723, 86 clinicians

Practice addresses (Care Compare)

1930 S Broad St
Philadelphia, PA 19145-2328
Phone (215) 685-1810

2230 Cottman Ave
Philadelphia, PA 19149-1230
Phone (215) 685-0602

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD490512PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clinical Care Associates of the University of Pennsylvania Health Internal Medicine CurrentSince Sep 1, 2025 Accepting new patients
City of Philadelphia CurrentSince Oct 4, 2025 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health CurrentSince Sep 1, 2025 Accepting new patients
City of Philadelphia CurrentSince Oct 4, 2025 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health Syst Internal Medicine Past Accepting new patients

Locations

1101 Market St
Fl 10
Philadelphia, PA 19107

2230 Cottman Ave
Philadelphia, PA 19149
Phone (215) 685-0603

800 Spruce St
#1W
Philadelphia, PA 19107
Phone (215) 829-7817

2230 Cottman Ave
#10
Philadelphia, PA 19149
Phone (215) 685-0602

800 Spruce St
Fl 1
Philadelphia, PA 19107
Phone (215) 829-5873

4400 Haverford Ave
#4
Philadelphia, PA 19104
Phone (215) 685-7600

800 Spruce St
William Penn Annex West, PA 19107
Phone (215) 829-3867

777 Township Line Rd
Ste 200
Yardley, PA 19067
Phone (215) 860-0775

Organizations & group practices 6

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": "1648512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757462400000",
    "number": "1063152114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191076192",
            "telephone_number": "215-829-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191076192",
            "telephone_number": "215-829-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2230 Cottman Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191491230",
            "country_code": "US",
            "telephone_number": "215-685-0603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "CARL",
        "middle_name": "DONGSEONG",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-29",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD490512",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.