Individual provider Active NPI

Okkyung Kim, M.D.

  • Neurology Physician
  • Oakland, CA
National Provider Identifier
1386871168
Registry record updated Mar 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
A111229 Issued in CA
Practice address
350 Hawthorne Ave
Oakland, CA 94609-3108
Phone
(510) 655-4000
NPI assigned
Jun 18, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X A111229 CA Primary

Addresses

Primary practice location

350 Hawthorne Ave
Oakland, CA 94609-3108

Mailing address

PO Box 276950
Sacramento, CA 95827-6950

Other practice location 1

575 Lennon Ln Ste 152
Walnut Creek, CA 94598-2443
Phone (925) 602-7060

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
I20120820000582 CA Practitioner - Neurology 9335396720 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Rush Medical College of Rush University, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

Practice addresses (Care Compare)

2450 Ashby Ave
Berkeley, CA 94705-2067
Phone (510) 204-4444

3200 Kearney St
Fremont, CA 94538-2299
Phone (510) 490-1222

350 Hawthorne Ave
Oakland, CA 94609-3108
Phone (510) 655-4000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
111229CAMDClinical Social Worker
A111229CAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter East Bay Medical Foundation Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: okim19005@ehr.johnmuirhealth.com

Organizations & group practices 2

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 2

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": "1245283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741305600000",
    "number": "1386871168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 276950",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958276950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 HAWTHORNE AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093108",
            "telephone_number": "510-655-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "575 Lennon Ln Ste 152",
            "address_purpose": "LOCATION",
            "city": "Walnut Creek",
            "state": "CA",
            "postal_code": "945982443",
            "country_code": "US",
            "telephone_number": "925-602-7060",
            "fax_number": "925-602-7070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "OKKYUNG",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-18",
        "last_updated": "2025-03-07",
        "certification_date": "2025-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A111229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.