Active NPI
Jeff Joohan Kim
- Physical Medicine & Rehabilitation Physician
- Las Vegas, NV
National Provider Identifier
1457092173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- LL3987
- Practice address
- 2880 N Tenaya Way FL 2
Las Vegas, NV 89128-0618 - Phone
- (424) 306-5571
- NPI assigned
- Apr 5, 2022
- 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 |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | LL3987 | NV | Primary |
Addresses
Primary practice location
2880 N Tenaya Way FL 2
Las Vegas, NV 89128-0618
Mailing address
2880 N Tenaya Way FL 2
Las Vegas, NV 89128-0618
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- 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 |
|---|---|---|---|---|
| I20230626000438 | NV | Order and Referring Only - Physical Medicine and Rehabilitation | 0547628414 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Interoperability endpoints
- jeff.kim@hca3.eclinicaldirectplus.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691539200000",
"number": "1457092173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2880 N TENAYA WAY FL 2",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891280618"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2880 N TENAYA WAY FL 2",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891280618",
"telephone_number": "424-306-5571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JEFF",
"middle_name": "JOOHAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-05",
"last_updated": "2023-08-09",
"certification_date": "2023-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "NV",
"license": "LL3987",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; 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.