NPIMap

Individual provider Active NPI

Namou Kim, MD

  • Otolaryngology Physician
  • Seattle, WA
National Provider Identifier
1336125798
Registry record updated Jun 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD60101869 Issued in WA
Practice address
1221 Madison St Ste 1523
Seattle, WA 98104-1342
Phone
(206) 292-6464
Fax
(206) 292-6498
NPI assigned
Dec 19, 2005
Last updated
Jun 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X MD60101869 WA Primary
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X MD60101869 WA

Addresses

Primary practice location

1221 Madison St Ste 1523
Seattle, WA 98104-1342

Mailing address

PO Box 25608
Salt Lake City, UT 84125-0608
Phone (206) 320-4476

Other identifiers 3

IdentifierTypeStateIssuer
298197OtherWADEPT OF LABOR & INDUSTRIES
8550915MedicaidWA
1336125798MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nkim1042145@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20090904000126 WA Practitioner - Otolaryngology 3870512825 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Swedish Health ServicesGroup PAC ID 0244138196, 1,038 clinicians

Practice addresses (Care Compare)

1221 Madison St
Suite 1523
Seattle, WA 98104-1342
Phone (206) 292-6464

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision20

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc P S Current Accepting new patients
Proliance Surgeons Inc P S Family Medicine CurrentSince Dec 1, 2019 Accepting new patients
Proliance Surgeons, Inc., P.S. CurrentSince Dec 1, 2019 Accepting new patients
Swedish Health Services CurrentSince Sep 1, 2009 Accepting new patients
Proliance Surgeons Inc PS CurrentSince Dec 27, 2020 Accepting new patients
Swedish Health Services Past Accepting new patients
Swedish Health Services Past Accepting new patients
Proliance Surgeons, Inc., P.S. Otolaryngology PastSince Mar 1, 2020 Accepting new patients

Locations

7320 216th St SW
Ste 310
Edmonds, WA 98026
Phone (425) 673-3800

104 27th Ave SE
Puyallup, WA 98374
Phone (253) 770-4099

3801 5th St SE
Ste 110
Puyallup, WA 98374
Phone (253) 845-9585

1221 Madison St
Ste 1523
Seattle, WA 98104
Phone (206) 292-6464

600 Broadway
Ste 200
Seattle, WA 98122
Phone (206) 215-1770

747 Broadway
Seattle, WA 98122
Phone (360) 658-2488

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

Interoperability endpoints

  • Direct secure messaging: nkim1042145@wm.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623801600000",
    "number": "1336125798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25608",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841250608",
            "telephone_number": "206-320-4476",
            "fax_number": "206-568-7043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 MADISON ST STE 1523",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041342",
            "telephone_number": "206-292-6464",
            "fax_number": "206-292-6498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "NAMOU",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-19",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WA",
            "license": "MD60101869",
            "primary": true
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "WA",
            "license": "MD60101869",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR & INDUSTRIES",
            "identifier": "298197",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8550915",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336125798",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nkim1042145@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1221 Madison St Ste 1523",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981041342",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.