NPIMap

Individual provider Active NPI

Ju Young Kim

  • Family Medicine Physician
  • Henderson, NC
National Provider Identifier
1255913042
Registry record updated Mar 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2023-02323 Issued in NC
Practice address
480 Ruin Creek Rd
Henderson, NC 27536-2929
Phone
(252) 492-3152
Fax
(252) 430-1928
NPI assigned
Apr 22, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2026

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 2023-02323 NC Primary

Addresses

Primary practice location

480 Ruin Creek Rd
Henderson, NC 27536-2929

Mailing address

480 Ruin Creek Rd
Henderson, NC 27536-2929
Phone (252) 492-3152

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20251119003818 NC Practitioner - Family Practice 6305255670 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Duke University School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

480 Ruin Creek Rd
Henderson, NC 27536-2929
Phone (252) 492-3152

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2023-02323NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Affiliated Physicians, Inc. Family Medicine CurrentSince Oct 6, 2025 Accepting new patients
Duke University Affiliated Physicians, Inc. Family Medicine Current Accepting new patients
Duke University Affiliated Physicians, Inc. Family Medicine CurrentSince Oct 6, 2025 Accepting new patients
Duke University Affiliated Physicians, Inc. Family Medicine Past Accepting new patients

Locations

480 Ruin Creek Rd
Henderson, NC 27536
Phone (252) 492-3152

Interoperability endpoints

  • Direct secure messaging: jkim353057@directhisp.wakemed.org
  • Direct secure messaging: jkim299730@direct.medicine.duke.edu

Organizations & group practices 4

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.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1619049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773705600000",
    "number": "1255913042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 RUIN CREEK RD",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275362929",
            "telephone_number": "252-492-3152",
            "fax_number": "252-430-1928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 RUIN CREEK RD",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275362929",
            "telephone_number": "252-492-3152",
            "fax_number": "252-430-1928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JU YOUNG",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-22",
        "last_updated": "2026-03-17",
        "certification_date": "2026-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2023-02323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NC

Sources for this page

Verify at the official NPI Registry.