Individual provider Active NPI

Nam Hoon Kim, D.C.

  • Chiropractor
  • Portland, OR
National Provider Identifier
1164820148
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5599 Issued in OR
Practice address
18206 SE Stark St
Portland, OR 97233-4863
Phone
(360) 521-5676
Fax
(833) 517-1922
NPI assigned
Dec 8, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH60514800 WA
Chiropractor 111N00000X 5599 OR Primary

Addresses

Primary practice location

18206 SE Stark St
Portland, OR 97233-4863

Mailing address

17405 SE Stark St
Portland, OR 97233-4500
Phone (360) 521-5576

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251006002829 WA Practitioner - Chiropractic 6507363710 Practice locations: Vancouver, WA

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Western States College of Chiropractic, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12535 SE 131St CT
Happy Valley, OR 97086-1684

13521 SE 3Rd Way
Suite 200
Vancouver, WA 98684-6909
Phone (360) 909-5032

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5599ORMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Impact Chiropractic Chiropractor CurrentSince Mar 3, 2024 Accepting new patients
Impact Chiropractic CurrentSince Mar 3, 2024 Accepting new patients
Namu Chiropractic Chiropractor PastSince Feb 1, 2024 Accepting new patients
Duncan Health Centers, LLC PastSince Mar 1, 2021 Accepting new patients
Nam Hoon Kim PC Chiropractor PastSince Mar 1, 2021 Accepting new patients

Locations

18206 SE Stark St
Portland, OR 97233
Phone (360) 521-5576

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1417996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715299200000",
    "number": "1164820148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17405 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972334500",
            "telephone_number": "360-521-5576",
            "fax_number": "833-517-1922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18206 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972334863",
            "telephone_number": "360-521-5676",
            "fax_number": "833-517-1922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "NAM",
        "middle_name": "HOON",
        "name_prefix": "Mr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-12-08",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH60514800",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "5599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.