Individual provider Active NPI

Paul Byunghun Kang

  • Surgical Physician Assistant
  • Phoenix, AZ
National Provider Identifier
1417657305
Registry record updated Aug 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
11122 Issued in AZ
Practice address
500 W Thomas Rd Ste 750&850
Phoenix, AZ 85013-4224
Phone
(602) 406-1150
Fax
(602) 406-1159
NPI assigned
Mar 8, 2023
Last updated
Aug 27, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 11122 AZ
Physician Assistant 363A00000X 085009645 IL
Surgical Physician Assistant 363AS0400X 11122 AZ Primary

Addresses

Primary practice location

500 W Thomas Rd Ste 750&850
Phoenix, AZ 85013-4224

Mailing address

PO Box 33269
Phoenix, AZ 85067-3269
Phone (602) 406-4786

Other practice location 1

611 W Park St
Urbana, IL 61801-2529
Phone (217) 383-3311

Other practice location 2

485 S Dobson Rd Ste 203
Chandler, AZ 85224-5604
Phone (480) 728-2690

Other practice location 3

305 W Jackson St Ste 206
Carbondale, IL 62901-1474
Phone (618) 457-5200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pkang83957@sih.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, AZ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230718002009 IL Practitioner - Physician Assistant 9234599580 Reassigns benefits to 2 organizations
I20250924003192 AZ Practitioner - Physician Assistant 9234599580 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sjhmc Physician ServicesGroup PAC ID 4486646197, 645 clinicians

Practice addresses (Care Compare)

500 W Thomas Rd
680 DHMG St Joseph's Pelvic Pain and Surg
Phoenix, AZ 85013-4235
Phone (602) 406-6017

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
11122AZMDPhysician Assistant
085009645ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Medical Group CurrentSince Jun 12, 2023 Accepting new patients
St. Joseph's Hospital and Medical Center CurrentSince Aug 30, 2020 Accepting new patients
Southern Illinois Medical Services, NFP CurrentSince May 27, 2025 Accepting new patients

Locations

485 S Dobson Rd
Ste 203
Chandler, AZ 85224
Phone (480) 728-2690

500 W Thomas Rd
Ste 750
Phoenix, AZ 85013
Phone (602) 406-1150

File 56765
Los Angeles, CA 90074

2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300

305 W Jackson St
Ste 206
Carbondale, IL 62901
Phone (618) 457-3006

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Interoperability endpoints

  • Direct secure messaging: pkangpa373955@carlehiedirect.net

Organizations & group practices 4

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": "1678233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756252800000",
    "number": "1417657305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33269",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850673269",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W THOMAS RD STE 750&850",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134224",
            "telephone_number": "602-406-1150",
            "fax_number": "602-406-1159"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "611 W Park St",
            "address_purpose": "LOCATION",
            "city": "Urbana",
            "state": "IL",
            "postal_code": "618012529",
            "country_code": "US",
            "telephone_number": "217-383-3311",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "485 S Dobson Rd Ste 203",
            "address_purpose": "LOCATION",
            "city": "Chandler",
            "state": "AZ",
            "postal_code": "852245604",
            "country_code": "US",
            "telephone_number": "480-728-2690",
            "fax_number": "480-728-2689",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "305 W Jackson St Ste 206",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629011474",
            "country_code": "US",
            "telephone_number": "618-457-5200",
            "fax_number": "618-457-5200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KANG",
        "first_name": "PAUL",
        "middle_name": "BYUNGHUN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-08",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "11122",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085009645",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "11122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pkang83957@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "305 W Jackson St Ste 206",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011474",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.