NPIMap

Individual provider Active NPI

Young Ho Kim, MD

  • Nephrology Physician
  • Tacoma, WA
National Provider Identifier
1417100207
Registry record updated May 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MD60744505 Issued in WA
Practice address
1901 S Union Ave Ste B7011
Tacoma, WA 98405-1807
Phone
(253) 627-5755
Fax
(253) 627-7385
NPI assigned
Oct 24, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD2008-0737 NM
Student in an Organized Health Care Education/Training Program 390200000X 101645666 NM
Nephrology Physician 207RN0300X MD60744505 WA Primary

Addresses

Primary practice location

1901 S Union Ave Ste B7011
Tacoma, WA 98405-1807

Mailing address

1901 S Union Ave Ste B7011
Tacoma, WA 98405-1807
Phone (253) 627-5755

Other identifiers 1

IdentifierTypeStateIssuer
MD60744505OtherWAMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, GU2 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
I20170609001324 WA Practitioner - NephrologyPractitioner - Internal Medicine 6406919323 Reassigns benefits to 1 organization
I20240215002998 GU Practitioner - Nephrology 6406919323 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pacific Nephrology Associates PSGroup PAC ID 3476441445, 6 clinicians
Pacific Med and NephrologyGroup PAC ID 1951296490, 14 clinicians

Practice addresses (Care Compare)

4545 PT Fsdick Dr NW
Suite 250
Gig Harbor, WA 98335-1700
Phone (253) 267-5755

736 Route 4
Suite 103
Sinajana, GU 96910-3368
Phone 6716497232201

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD2008-0737NMMDInternal Medicine Physician
MD60744505WAMDNephrology Physician
101645666NMMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Guam Memorial Hospital CurrentSince Feb 2, 2024 Accepting new patients
Guam Memorial Hospital CurrentSince Feb 2, 2024 Accepting new patients
Pacific Med & Nephrology CurrentSince Jan 29, 2024 Accepting new patients
Advanced Eyecare, LLC PastSince Jan 29, 2024 Accepting new patients

Locations

736 Route 4
Ste 103
Sinajana, GU 96910
Phone (671) 649-7232

850 Gov Carlos G Camacho Rd
Tamuning, GU 96913
Phone (671) 647-2555

850 Gov Carlos G Camacho Rd
#R
Tamuning, GU 96913
Phone (671) 647-2552

Interoperability endpoints

  • Direct secure messaging: ykim313941@direct.multicare.org

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 and National Provider Directory roles.

Hospital & facility affiliations 10

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": "1224806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525651200000",
    "number": "1417100207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 S UNION AVE STE B7011",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984051807",
            "telephone_number": "253-627-5755",
            "fax_number": "253-627-7385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 S UNION AVE STE B7011",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984051807",
            "telephone_number": "253-627-5755",
            "fax_number": "253-627-7385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "YOUNG HO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-24",
        "last_updated": "2018-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NM",
            "license": "MD2008-0737",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NM",
            "license": "101645666",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "WA",
            "license": "MD60744505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "MD60744505",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.