Active NPI
Nahae Kim, MD, MPH
- Family Medicine Physician
- Kenosha, WI
National Provider Identifier
1366147399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 87853-20
- Practice address
- 10222 74TH St
Kenosha, WI 53142-6810 - Phone
- (262) 948-2600
- NPI assigned
- Mar 31, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | 87853-20 | WI | Primary |
| Family Medicine Physician | 207Q00000X | 125.081885 | IL |
Addresses
Primary practice location
10222 74TH St
Kenosha, WI 53142-6810
Mailing address
PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250
Other practice location 1
1475 E Belvidere Rd Unit 385
Grayslake, IL 60030-2026
Phone (847) 535-7157
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100428490 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230710000124 | IL | Order and Referring Only - Family Practice | 6406215474 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- nkim646137@direct.ochin.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1680220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790035200000",
"number": "1366147399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 735044",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606735044",
"telephone_number": "800-326-2250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10222 74TH ST",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531426810",
"telephone_number": "262-948-2600"
}
],
"practiceLocations": [
{
"address_1": "1475 E Belvidere Rd Unit 385",
"address_purpose": "LOCATION",
"city": "Grayslake",
"state": "IL",
"postal_code": "600302026",
"country_code": "US",
"telephone_number": "847-535-7157",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "NAHAE",
"credential": "MD, MPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-31",
"last_updated": "2026-09-22",
"certification_date": "2026-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "87853-20",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "125.081885",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100428490",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.