Active NPI
Eun Jung Kim
- Family Nurse Practitioner
- Carrollton, TX
National Provider Identifier
1255968004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP144588
- Practice address
- 4444 Saukenuk LN
Carrollton, TX 75010-1203 - Phone
- (469) 774-7197
- NPI assigned
- Mar 23, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP144588 | TX | Primary |
Addresses
Primary practice location
4444 Saukenuk LN
Carrollton, TX 75010-1203
Mailing address
4444 Saukenuk LN
Carrollton, TX 75010-1203
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP144588 | TX | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624579200000",
"number": "1255968004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4444 SAUKENUK LN",
"city": "CARROLLTON",
"state": "TX",
"postal_code": "750101203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4444 SAUKENUK LN",
"city": "CARROLLTON",
"state": "TX",
"postal_code": "750101203",
"telephone_number": "469-774-7197"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "EUN",
"middle_name": "JUNG",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-23",
"last_updated": "2021-06-25",
"certification_date": "2021-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TX",
"license": "AP144588",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carrollton, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.