Active NPI
Paul Byunghun Kang
- Surgical Physician Assistant
- Phoenix, AZ
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 11122
- 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, 2025
- Sex
- Male
- 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 |
|---|---|---|---|---|
| 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
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | pkang83957@sih.direct-ci.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL, AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
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
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
| License | State | Type | Specialty |
|---|---|---|---|
| 11122 | AZ | MD | Physician Assistant |
| 085009645 | IL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carle Health Medical Group | Current | Accepting new patients | |
| St. Joseph's Hospital and Medical Center | Current | Accepting new patients | |
| Southern Illinois Medical Services, NFP | Current | 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
- 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.
-
dba St. Joseph's Faculty Physicians
- Multi-Specialty Clinic/Center
- Phoenix, AZ
- NPI 1326098005
-
dba Carle Physician Group
- Internal Medicine Physician
- Urbana, IL
- NPI 1154653947
-
dba SIH Medical Group
- Internal Medicine Physician
- Carbondale, IL
- NPI 1770656837
-
dba SJHMC Trauma Services
- Emergency Care Clinic/Center
- Phoenix, AZ
- NPI 1255382412
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Chandler Regional Medical Center
- General Acute Care Hospital
- Chandler, AZ
- NPI 1700910189
-
dba St. Josephs Hospital and Medical Center Emergency Dept-Litchfield Park
- Emergency Care Clinic/Center
- Litchfield Park, AZ
- NPI 1265065445
Hospital
-
dba St. Josephs Hospital and Medical Center Emergency Dept-Glendale
- Emergency Care Clinic/Center
- Glendale, AZ
- NPI 1609408665
Hospital
-
dba St. Joseph's Hospital and Medical Center
- General Acute Care Hospital
- Phoenix, AZ
- NPI 1982733655
-
dba St. Joseph's Westgate Medical Center
- General Acute Care Hospital
- Glendale, AZ
- NPI 1992131734
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.