Active NPI
Soo Kim, R.D. L.D.
- Registered Dietitian
- Plano, TX
National Provider Identifier
1639511546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DT05776
- Practice address
- 1013 Ledgemont Dr
Plano, TX 75025-3510 - Phone
- (214) 932-5573
- NPI assigned
- Jul 19, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DT05776 | TX | Primary |
Addresses
Primary practice location
1013 Ledgemont Dr
Plano, TX 75025-3510
Mailing address
1013 Ledgemont Dr
Plano, TX 75025-3510
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT05776 | TX | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
| American Health Assessments LLC | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Registered Dietitian
- Denton, TX
- NPI 1497027098
Dietitian, Registered
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374710400000",
"number": "1639511546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1013 LEDGEMONT DR",
"city": "PLANO",
"state": "TX",
"postal_code": "750253510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1013 LEDGEMONT DR",
"city": "PLANO",
"state": "TX",
"postal_code": "750253510",
"telephone_number": "214-932-5573"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SOO",
"credential": "R.D. L.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-07-19",
"last_updated": "2013-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "DT05776",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plano, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 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.