Individual provider Active NPI

Hyun Kang, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Santa Rosa, CA
National Provider Identifier
1316917883
Registry record updated Nov 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
C54908 Issued in CA
Practice address
1165 Montgomery Dr
Santa Rosa, CA 95405-4801
Phone
(707) 547-5437
Fax
(707) 547-5430
NPI assigned
Jan 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 4301082719 MI
Critical Care Medicine (Internal Medicine) Physician 207RC0200X C54908 CA Primary

Addresses

Primary practice location

1165 Montgomery Dr
Santa Rosa, CA 95405-4801

Mailing address

1165 Montgomery Dr
Santa Rosa, CA 95405-4801
Phone (707) 547-5437

Other identifiers 2

IdentifierTypeStateIssuer
45S8848MedicaidMI
CA2184OtherMIRAILROAD MEDICARE

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address hkang1657876@oc.providencedirect.org
Direct Messaging Address hkang1657876@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120905000427 CA Practitioner - Critical Care (Intensivists)Practitioner - Internal Medicine 1052207081 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Internal Medicine
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

1165 Montgomery Dr
Santa Rosa, CA 95405-4801
Phone (707) 546-3210

Hospital & facility affiliations

  • Providence Santa Rosa Memorial Hospital Hospital, Santa Rosa, CA, CCN 050174
  • Petaluma Valley Hospital Hospital, Petaluma, CA, CCN 050136
  • Providence St Joseph Hospital Hospital, Eureka, CA, CCN 050006
  • Sutter Santa Rosa Regional Hospital Hospital, Santa Rosa, CA, CCN 050291
  • Adventist Health Ukiah Valley Hospital, Ukiah, CA, CCN 050301

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C54908CAMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Aug 15, 2012 Accepting new patients
Providence Medical Foundation CurrentSince Aug 15, 2012 Accepting new patients
Providence Medical Foundation Past Accepting new patients
Northern Valley Anesthesiology, P.a. Past Accepting new patients
Englewood Hyperbaric, P.a. Past Accepting new patients
Bronson Methodist Hospital Past Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 400
Anaheim, CA 92805

3300 Renner Dr
Fortuna, CA 95540
Phone (707) 725-3361

1375 University St
Healdsburg, CA 95448
Phone (707) 385-2025

400 N McDowell Blvd
Petaluma, CA 94954
Phone (707) 778-1111

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

1165 Montgomery Dr
Santa Rosa, CA 95405
Phone (707) 525-5300

500 Doyle Park Dr
Ste G04
Santa Rosa, CA 95405
Phone (707) 303-8360

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

Interoperability endpoints

  • Direct secure messaging: hkang1657876@oc.providencedirect.org

Organizations & group practices 8

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 7

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

NPI Registry JSON

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635897600000",
    "number": "1316917883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1165 MONTGOMERY DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054801",
            "telephone_number": "707-547-5437",
            "fax_number": "707-547-5430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1165 MONTGOMERY DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054801",
            "telephone_number": "707-547-5437",
            "fax_number": "707-547-5430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANG",
        "first_name": "HYUN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "MI",
            "license": "4301082719",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "CA",
            "license": "C54908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45S8848",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA2184",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hkang1657876@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1165 Montgomery Dr",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954054801",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hkang1657876@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "500 Doyle Park Dr Ste G04",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954054559",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.