Jae Koul Kim, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

32890 Issued in AZ

Practice address

4729 E Sunrise Dr # 315
Tucson, AZ 85718-4534

Phone

(520) 429-2023

NPI assigned

Jan 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Medical X-Ray Consultants, LTD

  • Vascular & Interventional Radiology Physician
  • Alexandria, MN
  • NPI 1386601383

  Body Imaging

  NPD (past)
• Medical Xray Consultants, LTD

  • Neurological Surgery Physician
  • Alexandria, MN
  • NPI 1679838023
  NPD (past)

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

{
    "created_epoch": "1138406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478649600000",
    "number": "1124099213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4729 E SUNRISE DR # 315",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857184534",
            "telephone_number": "520-429-2023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4729 E SUNRISE DR # 315",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857184534",
            "telephone_number": "520-429-2023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JAE",
        "middle_name": "KOUL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-28",
        "last_updated": "2016-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AZ",
            "license": "32890",
            "primary": true
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "AZ",
            "license": "32890",
            "primary": false
        },
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "AZ",
            "license": "32890",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN INDIVIDUAL NPI",
            "identifier": "1124099213",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE RAILROAD ID & PTAN",
            "identifier": "CS7943",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE ID",
            "identifier": "ZWCBBM",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICAID ID",
            "identifier": "005472",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1841261989",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "861725",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00109556",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Muhun Kim, DDS, MS
• Darlyne S Kim, AU.D.
• Eun J Kim, PHARM.D.
• Faith Sun-Mi Kim, MD
• Hyun Kim
• Justin Kim, DO
• Kaian Kim
• Morgan Song Kim, MD. MED
• Nathaniel Jinyoung Kim, MD
• Robert Kim, MD

• Diagnostic Radiology Physician in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Diagnostic Radiology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.