Active NPI
Jong Gu Kim, MD
- Otolaryngology Physician
- Ashtabula, OH
National Provider Identifier
1265449961
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 35365
- Practice address
- 2221 East Prospect
Ashtabula, OH 44004 - Phone
- (440) 997-5781
- Fax
- (440) 997-5725
- NPI assigned
- Aug 2, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 35365 | OH | Primary |
Addresses
Primary practice location
2221 East Prospect
Ashtabula, OH 44004
Mailing address
2221 East Prospect
Ashtabula, OH 44004
Phone (440) 997-5781
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0217661 | Medicaid | OH |
Other names 1
- Jong Gu Kim
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35365 | OH | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191369600000",
"number": "1265449961",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2221 EAST PROSPECT",
"city": "ASHTABULA",
"state": "OH",
"postal_code": "44004",
"telephone_number": "440-997-5781",
"fax_number": "440-997-5725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2221 EAST PROSPECT",
"city": "ASHTABULA",
"state": "OH",
"postal_code": "44004",
"telephone_number": "440-997-5781",
"fax_number": "440-997-5725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JONG",
"middle_name": "GU",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-02",
"last_updated": "2007-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "OH",
"license": "35365",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0217661",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JONG",
"last_name": "KIM",
"middle_name": "GU",
"credential": "MD PMA INC",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Ashtabula, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.