Active NPI
Kenneth Su Kim, M.D.
- Internal Medicine Physician
- Sterling, VA
National Provider Identifier
1629264726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 0101234789
- Practice address
- 47100 Community PLZ
Suite 100
Sterling, VA 20164-1826 - Phone
- (703) 880-1403
- Fax
- (703) 880-1404
- NPI assigned
- Sep 21, 2007
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 0101234789 | VA | Primary |
Addresses
Primary practice location
47100 Community PLZ
Suite 100
Sterling, VA 20164-1826
Mailing address
PO Box 758963
Baltimore, MD 21275-8963
Phone (804) 968-5700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medics USA, Inc | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/CECEAD
Organizations & group practices 1
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.
-
- Emergency Medical Services (Emergency Medicine) Physician
- Purcellville, VA
- NPI 1396870606
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357689600000",
"number": "1629264726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 758963",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212758963",
"telephone_number": "804-968-5700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "47100 COMMUNITY PLZ",
"address_2": "SUITE 100",
"city": "STERLING",
"state": "VA",
"postal_code": "201641826",
"telephone_number": "703-880-1403",
"fax_number": "703-880-1404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "KENNETH",
"middle_name": "SU",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-21",
"last_updated": "2013-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "VA",
"license": "0101234789",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sterling, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.