Individual provider Active NPI

Roger Hoon Kim, MD

  • Surgical Oncology Physician
  • Danville, IL
National Provider Identifier
1225237704
Registry record updated Nov 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Oncology PhysicianTaxonomy code 2086X0206X
License
036-144271 Issued in IL
Practice address
1900 E Main St
Danville, IL 61832-5100
Phone
(217) 554-3000
NPI assigned
Jul 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Oncology Physician 2086X0206X MD.203302 LA
Surgical Oncology Physician 2086X0206X 0101241581 VA
Surgery Physician 208600000X 036-144271 IL
Surgical Oncology Physician 2086X0206X 036-144271 IL Primary

Addresses

Primary practice location

1900 E Main St
Danville, IL 61832-5100

Mailing address

2520 Clayton Blvd
Champaign, IL 61822-2387
Phone (631) 987-7168

Other identifiers 1

IdentifierTypeStateIssuer
036-144271OtherILSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-144271ILMDSurgery Physician
MD.203302LAMDSurgical Oncology Physician
0101241581VAMDSurgical Oncology Physician

NPI Registry JSON

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

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698796800000",
    "number": "1225237704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 CLAYTON BLVD",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618222387",
            "telephone_number": "631-987-7168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 E MAIN ST",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618325100",
            "telephone_number": "217-554-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ROGER",
        "middle_name": "HOON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-13",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "LA",
            "license": "MD.203302",
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "VA",
            "license": "0101241581",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036-144271",
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "IL",
            "license": "036-144271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036-144271",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, IL

Sources for this page

Verify at the official NPI Registry.