Active NPI
Da Hun Kim
- Medical Physician Assistant
- Clinton, MD
National Provider Identifier
1083258610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- Practice address
- 7503 Surratts Rd Ste 208
Clinton, MD 20735-3358 - Phone
- (301) 877-4367
- NPI assigned
- Nov 6, 2019
- Reactivated
- Jun 3, 2024
- Last updated
- Jun 26, 2024
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Medical Physician Assistant | 363AM0700X | MD | Primary |
Addresses
Primary practice location
7503 Surratts Rd Ste 208
Clinton, MD 20735-3358
Mailing address
7503 Surratts Rd
Clinton, MD 20735-3358
Phone (352) 361-5116
Other practice location 1
8001 Beaty Grove Dr
Tampa, FL 33626-1602
Phone (813) 926-5454
Other names 1
- John Kim
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Surgery Physician
- Washington, DC
- NPI 1528345378
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1572998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719360000000",
"number": "1083258610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7503 SURRATTS RD",
"city": "CLINTON",
"state": "MD",
"postal_code": "207353358",
"telephone_number": "352-361-5116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7503 SURRATTS RD STE 208",
"city": "CLINTON",
"state": "MD",
"postal_code": "207353358",
"telephone_number": "301-877-4367"
}
],
"practiceLocations": [
{
"address_1": "8001 Beaty Grove Dr",
"address_purpose": "LOCATION",
"city": "Tampa",
"state": "FL",
"postal_code": "336261602",
"country_code": "US",
"telephone_number": "813-926-5454",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "DA HUN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-11-06",
"last_updated": "2024-06-26",
"certification_date": "2024-06-26",
"deactivation_date": "2024-05-15",
"reactivation_date": "2024-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "MD",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JOHN",
"last_name": "KIM",
"credential": "PA-C",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Clinton, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; 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.