NPIMap

Organization Active NPI

Stepping Stone Pediatrics, LLC

  • Primary Care Clinic/Center
  • Kennesaw, GA
National Provider Identifier
1477939676
Registry record updated Aug 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
039144 Issued in GA
Legal business name
STEPPING STONE PEDIATRICS, LLC
Practice address
1770 Dennis Kemp LN NW
Kennesaw, GA 30152-3938
Phone
(770) 515-9000
Fax
(678) 813-3355
NPI assigned
Aug 11, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2015

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

Authorized official

Name
Dr. Kyoung-Soon Kim, M.D.NPI 1760473276
Title
Managing Partner
Phone
(770) 862-1166

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 039144 GA Primary

Addresses

Primary practice location

1770 Dennis Kemp LN NW
Kennesaw, GA 30152-3938

Mailing address

1770 Dennis Kemp LN NW
Kennesaw, GA 30152-3938
Phone (770) 515-9000

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2103185Stepping Stone Pediatrics, LLC1770 Dennis Kemp Lane, Kennesaw, GA 30152Certificate of waiverOct 6, 2027

National Provider Directory

National Provider Directory

Locations

1770 Dennis Kemp Ln NW
Kennesaw, GA 30152
Phone (770) 515-9000

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1439251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439251200000",
    "number": "1477939676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 DENNIS KEMP LN NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301523938",
            "telephone_number": "770-515-9000",
            "fax_number": "678-813-3355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 DENNIS KEMP LN NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301523938",
            "telephone_number": "770-515-9000",
            "fax_number": "678-813-3355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPPING STONE PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-11",
        "last_updated": "2015-08-11",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "KYOUNG-SOON",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "770-862-1166",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "039144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennesaw, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.

Verify at the official NPI Registry.