Individual provider Active NPI

Kevin Chung

  • Emergency Medicine Physician
  • Baltimore, MD
National Provider Identifier
1326465303
Registry record updated Dec 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
4842 Issued in MD
Practice address
1830 E Monument St Ste 6-100
Baltimore, MD 21287-0020
Phone
(410) 955-5107
NPI assigned
Mar 27, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 4842 MD Primary

Addresses

Primary practice location

1830 E Monument St Ste 6-100
Baltimore, MD 21287-0020

Mailing address

929 N Wolfe St
Apt 1811a
Baltimore, MD 21205-1132
Phone (858) 722-5224

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20190412000922 CA Practitioner - Emergency Medicine 0840414348 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4842MDMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 19, 2018 Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 19, 2018 Accepting new patients

Locations

13652 Cantara St
Panorama City, CA 91402
Phone (818) 375-2417

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1395878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638921600000",
    "number": "1326465303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 N WOLFE ST",
            "address_2": "APT 1811A",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212051132",
            "telephone_number": "858-722-5224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 E MONUMENT ST STE 6-100",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212870020",
            "telephone_number": "410-955-5107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "KEVIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-27",
        "last_updated": "2021-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MD",
            "license": "4842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "13652 Cantara St",
            "city": "Panorama City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "914025423",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.