John Myoung Koo Kim, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35-100108 Issued in OH

Practice address

1115 Wooster Rd W
Barberton, OH 44203

Phone

(330) 825-6892

Fax

(330) 825-2782

NPI assigned

Jan 18, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1293667200000",
    "number": "1619957487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 WOOSTER RD W",
            "city": "BARBERTON",
            "state": "OH",
            "postal_code": "44203",
            "telephone_number": "330-825-6892",
            "fax_number": "330-825-2782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 WOOSTER RD W",
            "city": "BARBERTON",
            "state": "OH",
            "postal_code": "44203",
            "telephone_number": "330-825-6892",
            "fax_number": "330-825-2782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JOHN",
        "middle_name": "MYOUNG KOO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2010-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35100108",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "OH",
            "license": "35100108",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-100108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0269865",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKMAN'S COMP",
            "identifier": "778938",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James P Kennedy, M.D.
• Ryan Philip Kennedy, CDCA
• Sherri Kennedy
• Gin Za Khai, MD
• Kritika Khanna
• Nicole King
• Denise Kirkwood, M.A., PSY. S.
• Amber Lale Kleiber, MSW, LISW
• Blane Allen Klein
• Gail P Klusty, LPN

• Family Medicine Physician in Barberton, OH
• Providers in Barberton, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.