NPIMap

Individual provider Active NPI

Stacy June Kim, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Las Vegas, NV
National Provider Identifier
1265633077
Registry record updated Oct 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
12851 Issued in NV
Practice address
4230 Burnham Ave
Associated Pathologists, Chartered
Las Vegas, NV 89119-5408
Phone
(702) 733-7866
Fax
(702) 792-1319
NPI assigned
May 30, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 12, 2018

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Cytopathology Physician 207ZC0500X A108582 CA
Cytopathology Physician 207ZC0500X 12851 NV
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X MD430805 PA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X A108582 CA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 12851 NV Primary

Addresses

Primary practice location

4230 Burnham Ave
Associated Pathologists, Chartered
Las Vegas, NV 89119-5408

Mailing address

4230 Burnham Ave
Associated Pathologists, Chartered
Las Vegas, NV 89119-5408
Phone (702) 733-7866

Other identifiers 3

IdentifierTypeStateIssuer
12851OtherNVMEDICAL LICENSE
1265633077MedicaidNV
A108582OtherCAMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20081121000020 NV Practitioner - Pathology 7719047745 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Northeastern Ohio University College of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hoffman, MD, Associated Pathologists CharteredGroup PAC ID 8224921861, 14 clinicians

Practice addresses (Care Compare)

4230 Burnham Ave
Las Vegas, NV 89119-5408
Phone (702) 733-7866

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A108582CAMDCytopathology Physician
MD430805PAMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hoffman, MD, Associated Pathologists Chartered Anatomic Pathology & Clinical Pathology CurrentSince Aug 14, 2008 Accepting new patients

Locations

4230 Burnham Ave
Las Vegas, NV 89119
Phone (702) 733-7866

4230 Burnham Ave
Ste 144
Las Vegas, NV 89119

Organizations & group practices 1

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539302400000",
    "number": "1265633077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4230 BURNHAM AVE",
            "address_2": "ASSOCIATED PATHOLOGISTS, CHARTERED",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891195408",
            "telephone_number": "702-733-7866",
            "fax_number": "702-792-1319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4230 BURNHAM AVE",
            "address_2": "ASSOCIATED PATHOLOGISTS, CHARTERED",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891195408",
            "telephone_number": "702-733-7866",
            "fax_number": "702-792-1319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "STACY",
        "middle_name": "JUNE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-30",
        "last_updated": "2018-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "CA",
            "license": "A108582",
            "primary": false
        },
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "NV",
            "license": "12851",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "PA",
            "license": "MD430805",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "A108582",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NV",
            "license": "12851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "12851",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265633077",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "A108582",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.