Seong Cheol Kim, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

4301039276 Issued in MI

Practice address

2647 Meadowwedge Loop
St Cloud, FL 34772

Phone

(407) 793-4608

Fax

(269) 651-1411

NPI assigned

Jul 28, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1457351702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2647 MEADOWWEDGE LOOP",
            "city": "ST CLOUD",
            "state": "FL",
            "postal_code": "34772",
            "telephone_number": "407-793-4608",
            "fax_number": "269-651-1411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2647 MEADOWWEDGE LOOP",
            "city": "ST CLOUD",
            "state": "FL",
            "postal_code": "34772",
            "telephone_number": "407-793-4608",
            "fax_number": "269-651-1411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SEONG",
        "middle_name": "CHEOL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "MI",
            "license": "039276",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "SK039276",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "4301039276",
            "primary": true
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "MI",
            "license": "039276",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4542300",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shauna J Keys, ARNP
• Mohammed I Khan, ARNP
• Muhammad Amir Khan, MD
• Rhoda Florance Kiaga, RPH
• Kids Corner Behavior Services Inc
• Deborah Kimble, LD CDE MSPH CPT
• Mustafa Kinaan
• Kathleen C. Klapheke, P.T.
• Stephanie Klotz, AUD
• Cheryl Jean Knouse

• General Practice Physician in St Cloud, FL
• Providers in St Cloud, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 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.

Verify at the official NPI Registry.