Active NPI
Randy Young Kim
- Student in an Organized Health Care Education/Training Program
- Lawrenceville, GA
National Provider Identifier
1447051578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 665 Duluth Hwy Ste 501
Lawrenceville, GA 30046-8709 - Phone
- (678) 312-0400
- NPI assigned
- Mar 24, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
665 Duluth Hwy Ste 501
Lawrenceville, GA 30046-8709
Mailing address
616 Clearwater Park Rd Apt 512
West Palm Beach, FL 33401-6245
Phone (478) 442-2638
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250528000120 | GA | Order and Referring Only - Family Practice | 9638698228 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1742774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742774400000",
"number": "1447051578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "616 CLEARWATER PARK RD APT 512",
"city": "WEST PALM BEACH",
"state": "FL",
"postal_code": "334016245",
"telephone_number": "478-442-2638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "665 DULUTH HWY STE 501",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300468709",
"telephone_number": "678-312-0400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "RANDY",
"middle_name": "YOUNG",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-03-24",
"last_updated": "2025-03-24",
"certification_date": "2025-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.