Individual provider Active NPI

Myunghoon Kim, MD

  • Internal Medicine Physician
  • Hershey, PA
National Provider Identifier
1073192860
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A196429 Issued in CA
Practice address
500 University Dr
Hershey, PA 17033-2360
Phone
(717) 531-8521
NPI assigned
Apr 7, 2021
Last updated
Jul 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A196429 CA Primary

Addresses

Primary practice location

500 University Dr
Hershey, PA 17033-2360

Mailing address

500 University Dr
Hershey, PA 17033-2360

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20240724002790 CA Practitioner - Internal Medicine 9931501269 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Pennsylvania State University College of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Enlightened Healthcare Alliance Medical CorporationGroup PAC ID 6608115043, 11 clinicians

Practice addresses (Care Compare)

354 Santa Fe Dr
Encinitas, CA 92024-5142
Phone (760) 230-2551

662 Encinitas Blvd
Suite 204
Encinitas, CA 92024-6789
Phone (833) 446-6363

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A196429CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Enlightened Healthcare Alliance Medical Corporation Internal Medicine CurrentSince Jul 1, 2024 Accepting new patients
North County Inpatient Medical Alliance, a Medical Group, Inc CurrentSince Jul 1, 2024 Accepting new patients
Encinitas Palliative Care Associates, Inc. Internal Medicine Past Accepting new patients
Premier Surgical Partners Inc PastSince Jul 1, 2024 Accepting new patients

Locations

354 Santa Fe Dr
Encinitas, CA 92024
Phone (760) 230-2251

662 Encinitas Blvd
Ste 204
Encinitas, CA 92024
Phone (760) 203-5545

9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123

Organizations & group practices 4

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

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1617753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1073192860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 UNIVERSITY DR",
            "city": "HERSHEY",
            "state": "PA",
            "postal_code": "170332360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 UNIVERSITY DR",
            "city": "HERSHEY",
            "state": "PA",
            "postal_code": "170332360",
            "telephone_number": "717-531-8521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MYUNGHOON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-07",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A196429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hershey, PA

Sources for this page

Verify at the official NPI Registry.