Individual provider Active NPI

Sung Kim

  • Child & Adolescent Psychiatry Physician
  • Salt Lake City, UT
National Provider Identifier
1174210587
Registry record updated Jul 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
14288530-1204 Issued in UT
Practice address
501 S Chipeta Way RM 1000
Salt Lake City, UT 84108-1222
Phone
(801) 585-5184
NPI assigned
Apr 18, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X 14288530-1204 UT Primary

Addresses

Primary practice location

501 S Chipeta Way RM 1000
Salt Lake City, UT 84108-1222

Mailing address

501 S Chipeta Way RM 1000
Salt Lake City, UT 84108-1222
Phone (801) 585-5184

Other practice location 1

25 Pocono Rd
Denville, NJ 07834-2954
Phone (973) 625-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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 1

Enrollment IDStateProvider typePAC IDDetails
I20260616004515 UT Order and Referring Only - PsychiatryPractitioner - Psychiatry 8527530989

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1681776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782950400000",
    "number": "1174210587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S CHIPETA WAY RM 1000",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081222",
            "telephone_number": "801-585-5184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S CHIPETA WAY RM 1000",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841081222",
            "telephone_number": "801-585-5184"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25 Pocono Rd",
            "address_purpose": "LOCATION",
            "city": "Denville",
            "state": "NJ",
            "postal_code": "078342954",
            "country_code": "US",
            "telephone_number": "973-625-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "SUNG",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-18",
        "last_updated": "2026-07-02",
        "certification_date": "2026-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "UT",
            "license": "14288530-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.