Individual provider Active NPI

Paul Han Soo Kim, M.D.

  • Family Medicine Physician
  • Walnut Creek, CA
National Provider Identifier
1609831163
Registry record updated Mar 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G86124 Issued in CA
Practice address
2637 Shadelands Dr
Walnut Creek, CA 94598-2512
Phone
(925) 288-2828
Fax
(925) 288-0829
NPI assigned
Apr 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G86124 CA Primary

Addresses

Primary practice location

2637 Shadelands Dr
Walnut Creek, CA 94598-2512

Mailing address

2637 Shadelands Dr
Walnut Creek, CA 94598-2512
Phone (925) 288-2828

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20051102000310 CA Practitioner - Family Practice 9133146897 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Bass Medical Group CurrentSince Jan 1, 2016 Accepting new patients
Bay Area Surgical Specialists, Inc a Medical Corporation CurrentSince Jan 1, 2016 Accepting new patients
Bass Medical Group Family Medicine Current Accepting new patients
John Muir Health Past Accepting new patients
Torrance Memorial Medical Center Past Accepting new patients
Bass Medical Group Past Accepting new patients
John Muir Health Past Accepting new patients

Locations

1505 Saint Alphonsus Way
Alamo, CA 94507
Phone (925) 837-4225

1776 Ygnacio Valley Rd
Ste 208
Walnut Creek, CA 94598
Phone (925) 937-0995

1776 Ygnacio Valley Rd
Ste 201
Walnut Creek, CA 94598
Phone (925) 288-0828

365 Lennon Ln
Ste 250
Walnut Creek, CA 94598
Phone (925) 627-3424

2637 Shadelands Dr
Walnut Creek, CA 94598
Phone (925) 627-3424

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741046400000",
    "number": "1609831163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2637 SHADELANDS DR",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945982512",
            "telephone_number": "925-288-2828",
            "fax_number": "925-288-0829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2637 SHADELANDS DR",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945982512",
            "telephone_number": "925-288-2828",
            "fax_number": "925-288-0829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "PAUL",
        "middle_name": "HAN SOO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2025-03-04",
        "certification_date": "2025-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G86124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.