Kisung Kim, BM

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

A141207 Issued in CA

Practice address

2450 Sister Mary Columba Dr
Red Bluff, CA 96080-4356

Phone

(530) 527-0414

Fax

(530) 527-3720

NPI assigned

Mar 17, 2014

Last updated

Apr 3, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: kisung.kimmd.p1@direct.schc.nextgenshare.com

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.

• Shasta Community Health Center

  dba Shasta Community Telemedicine and Training Center

  • Federally Qualified Health Center (FQHC)
  • Redding, CA
  • NPI 1114533171
  Medicare reassignment

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

{
    "created_epoch": "1395014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554249600000",
    "number": "1073939815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 SISTER MARY COLUMBA DR",
            "city": "RED BLUFF",
            "state": "CA",
            "postal_code": "960804356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 SISTER MARY COLUMBA DR",
            "city": "RED BLUFF",
            "state": "CA",
            "postal_code": "960804356",
            "telephone_number": "530-527-0414",
            "fax_number": "530-527-3720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "KISUNG",
        "credential": "BM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-17",
        "last_updated": "2019-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CA",
            "license": "A141207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Palwinder Pal Kaur, BACHELOR OF SCIENCE
• Barbara Kellogg
• Karen Marie Kemp, ASW
• Kyra Kilmer, NP
• Jeonghoon Kim, MD
• Daniel McKenzie King, MD
• Michael Chad Kingsley, DO
• Terry D Kinney, PA-C
• Ashton Brooke Kinyon, FNP-C
• Bethany Koelker

• Pediatric Adolescent Medicine Physician in Red Bluff, CA
• Providers in Red Bluff, CA by specialty
• Pediatric Adolescent Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.