Individual provider Active NPI

John Y Kim, DO

  • Emergency Medicine Physician
  • Longview, WA
National Provider Identifier
1114288560
Registry record updated Jan 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
OP60648272 Issued in WA
Practice address
1615 Delaware St
Longview, WA 98632-2367
Phone
(360) 636-4831
NPI assigned
Jun 1, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X OS018199 PA
Emergency Medicine Physician 207P00000X OP60648272 WA Primary

Addresses

Primary practice location

1615 Delaware St
Longview, WA 98632-2367

Mailing address

1615 Delaware St
Longview, WA 98632-2367
Phone (360) 636-4831

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, RI, WA3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20161201000861 NY Practitioner - Emergency Medicine 1153613971 Reassigns benefits to 1 organization
I20180228002171 RI Practitioner - Emergency Medicine 1153613971 Reassigns benefits to 2 organizations
I20180924002438 WA Practitioner - Emergency Medicine 1153613971 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Swedish Health ServicesGroup PAC ID 9537072814, 384 clinicians
Eastside Emergency Physicians PLLCGroup PAC ID 5193725372, 56 clinicians

Practice addresses (Care Compare)

18100 NE Union Hill Rd
Suite 200
Redmond, WA 98052-3330
Phone (206) 320-5190

751 NE Blakely Dr
Issaquah, WA 98029-6201
Phone (425) 394-0610

Hospital & facility affiliations

  • Swedish Medical Center Hospital, Seattle, WA, CCN 500027
  • Swedish Issaquah Hospital, Issaquah, WA, CCN 500152

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS018199PAMDEmergency Medicine Physician
OP60648272WAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Swedish Health Services CurrentSince Jul 15, 2024 Accepting new patients
Eastside Emergency Physicians, PLLC Emergency Medicine CurrentSince Mar 30, 2022 Accepting new patients
Emergency Physician Associates of New England PC Emergency Medicine CurrentSince Jan 1, 2018 Accepting new patients
Swedish Health Services CurrentSince Jul 15, 2024 Accepting new patients
Swedish Health Services Current Accepting new patients
Eastside Emergency Physicians PLLC Emergency Medicine CurrentSince Mar 30, 2022 Accepting new patients
Emergency Physician Services of New York, P.C. Emergency Medicine CurrentSince Jul 13, 2016 Accepting new patients
Emergency Care Services of New England PC Emergency Medicine CurrentSince Jan 1, 2018 Accepting new patients

Locations

2209 Genesee St
Utica, NY 13501
Phone (315) 798-8100

200 High Service Ave
North Providence, RI 02904
Phone (401) 456-3000

100 Kenyon Ave
Wakefield, RI 02879
Phone (401) 782-8000

13020 Meridian Ave S
Everett, WA 98208
Phone (425) 357-3700

751 NE Blakely Dr
Issaquah, WA 98029
Phone (425) 313-4000

18100 NE Union Hill Rd
Redmond, WA 98052
Phone (425) 498-2020

18100 NE Union Hill Rd
Ste 200
Redmond, WA 98052
Phone (206) 320-5190

2450 33rd Ave W
Ste 100
Seattle, WA 98199
Phone (206) 320-3364

Interoperability endpoints

  • Direct secure messaging: jkim388660@direct.peacehealth.org

Organizations & group practices 8

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.

Hospital & facility affiliations 2

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": "1338508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641859200000",
    "number": "1114288560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 DELAWARE ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322367",
            "telephone_number": "360-636-4831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 DELAWARE ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322367",
            "telephone_number": "360-636-4831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JOHN",
        "middle_name": "Y",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-01",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "OS018199",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "OP60648272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, WA

Sources for this page

Verify at the official NPI Registry.