NPIMap

Individual provider Active NPI

Kwon Soo Kim, MD

  • Nephrology Physician
  • Philadelphia, PA
National Provider Identifier
1376064097
Registry record updated Dec 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MD476584 Issued in PA
Practice address
700 Spruce St.
Suite 403
Philadelphia, PA 19106-5109
Phone
(215) 829-8420
Fax
(215) 829-8418
NPI assigned
Jul 3, 2017
Last updated
Dec 29, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD476584 PA
Nephrology Physician 207RN0300X MD476584 PA Primary

Addresses

Primary practice location

700 Spruce St.
Suite 403
Philadelphia, PA 19106-5109

Mailing address

700 Spruce St.
Suite 403
Philadelphia, PA 19106-5109
Phone (215) 829-8420

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220927003345 PA Practitioner - NephrologyPractitioner - Internal Medicine 2668897752 Reassigns benefits to 1 organization
I20250730004821 NJ Practitioner - Internal Medicine 2668897752 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hudson MD GroupGroup PAC ID 6103240478, 110 clinicians

Practice addresses (Care Compare)

1625 Anderson Ave
Suite 204
Fort Lee, NJ 07024-2748
Phone (201) 224-0011

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Clinical Care Associates of the University of Pennsylvania Health Nephrology CurrentSince Jul 4, 2022 Accepting new patients
Hudson MD Group Internal Medicine CurrentSince May 8, 2025 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health CurrentSince Jul 4, 2022 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health Internal Medicine Current Accepting new patients
David W. Lee MD PA PastSince Feb 6, 2007 Accepting new patients

Locations

1625 Anderson Ave
Ste 204
Fort Lee, NJ 07024
Phone (201) 224-0011

784 Grand Ave
Ste 201
Ridgefield, NJ 07657
Phone (201) 346-0999

9 Hospital Dr
Ste A22
Toms River, NJ 08755
Phone (973) 429-1300

700 Spruce St
Ste 403
Philadelphia, PA 19106
Phone (215) 829-6089

777 Township Line Rd
Ste 200
Yardley, PA 19067
Phone (215) 860-0775

Organizations & group practices 5

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 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": "1499040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672272000000",
    "number": "1376064097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 SPRUCE ST.",
            "address_2": "SUITE 403",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191065109",
            "telephone_number": "215-829-8420",
            "fax_number": "215-829-8418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 SPRUCE ST.",
            "address_2": "SUITE 403",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191065109",
            "telephone_number": "215-829-8420",
            "fax_number": "215-829-8418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "KWON SOO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-03",
        "last_updated": "2022-12-29",
        "certification_date": "2022-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD476584",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "PA",
            "license": "MD476584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.