Active NPI
Seung Soo Kim, MD
- Anatomic Pathology & Clinical Pathology Physician
- Fort Wayne, IN
National Provider Identifier
1639153182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 01040258A
- Practice address
- 11109 Parkview Plaza Dr
Fort Wayne, IN 46845-1701 - Phone
- (260) 266-1000
- NPI assigned
- Nov 29, 2005
- 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 |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 01040258A | IN | Primary |
Addresses
Primary practice location
11109 Parkview Plaza Dr
Fort Wayne, IN 46845-1701
Mailing address
2458 Lake Ave
Fort Wayne, IN 46805-5406
Phone (260) 424-2195
Other practice location 1
2200 Randallia Dr
Ft Wayne, IN 46805-4638
Phone (800) 899-5757
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100364240 | Medicaid | IN |
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 |
|---|---|---|---|
| Fort Wayne Medical Laboratory Corporation | Anatomic Pathology & Clinical Pathology | Past | Accepting new patients |
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.
-
- Medical Laboratory Technician
- Ft Wayne, IN
- NPI 1285610733
Anatomic Pathology & Clinical Pathology
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534809600000",
"number": "1639153182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2458 LAKE AVE",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468055406",
"telephone_number": "260-424-2195",
"fax_number": "260-422-0077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11109 PARKVIEW PLAZA DR",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468451701",
"telephone_number": "260-266-1000"
}
],
"practiceLocations": [
{
"address_1": "2200 Randallia Dr",
"address_purpose": "LOCATION",
"city": "Ft Wayne",
"state": "IN",
"postal_code": "468054638",
"country_code": "US",
"telephone_number": "800-899-5757",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "SEUNG",
"middle_name": "SOO",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-29",
"last_updated": "2018-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "IN",
"license": "01040258A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100364240",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.