NPIMap

Individual provider Active NPI

Edward Hyounwoo Kim, MD

  • Family Medicine Physician
  • Oakley, CA
National Provider Identifier
1124342977
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A126368 Issued in CA
Practice address
2021 Main St
Oakley, CA 94561-3302
Phone
(925) 776-8200
Fax
(925) 776-8260
NPI assigned
Mar 23, 2010
Last updated
Mar 9, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A126368 CA Primary

Addresses

Primary practice location

2021 Main St
Oakley, CA 94561-3302

Mailing address

PO Box 22210
Oakland, CA 94623-2210
Phone (510) 535-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181008003288 CA Practitioner - Family Practice 4486872983 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
State University of New York at Buffalo School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
La Clinica de la Raza IncGroup PAC ID 1557258282, 130 clinicians

Practice addresses (Care Compare)

2021 Main St
Oakley, CA 94561-3302
Phone (925) 776-8200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A126368CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
La Clinica de la Raza Inc CurrentSince Aug 1, 2018 Accepting new patients
La Clinica de la Raza Inc CurrentSince Aug 1, 2018 Accepting new patients
Alta Bates Summit Medical Center Past Accepting new patients
Sutter Delta Medical Center Past Accepting new patients
Alameda Health System Past Accepting new patients
La Clinica de la Raza, Inc. Past Accepting new patients
Eden Medical Center/San Leandro Hospital Campus Past Accepting new patients
Alameda Health System Past Accepting new patients

Locations

2021 Main St
Oakley, CA 94561
Phone (925) 776-8200

220 Hospital Dr
Vallejo, CA 94589
Phone (707) 641-1900

Interoperability endpoints

  • Direct secure messaging: ekim293716@direct.ochin.org

Organizations & group practices 9

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": "1269302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1124342977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22210",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946232210",
            "telephone_number": "510-535-4000",
            "fax_number": "510-535-4189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 MAIN ST",
            "city": "OAKLEY",
            "state": "CA",
            "postal_code": "945613302",
            "telephone_number": "925-776-8200",
            "fax_number": "925-776-8260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "EDWARD",
        "middle_name": "HYOUNWOO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-23",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A126368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakley, CA

Sources for this page

Verify at the official NPI Registry.