Individual provider Active NPI

Daniel Byeongheui Kim, MD

  • Vascular Surgery Physician
  • Everett, WA
National Provider Identifier
1639513229
Registry record updated Sep 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
MD61068288 Issued in WA
Practice address
1330 Rockefeller Ave Ste 520
Everett, WA 98201-1677
Phone
(425) 297-5200
Fax
(425) 259-8600
NPI assigned
Apr 25, 2013
Last updated
Sep 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X MD61068288 WA Primary

Addresses

Primary practice location

1330 Rockefeller Ave Ste 520
Everett, WA 98201-1677

Mailing address

1330 Rockefeller Ave Ste 520
Everett, WA 98201-1677
Phone (877) 644-8346

Other practice location 1

55 Fruit St
Boston, MA 02114
Phone (877) 644-8346

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20200824000240 WA Practitioner - Vascular Surgery 9537309448 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
University of Cincinnati College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1321 Colby Ave
Everett, WA 98201-1665
Phone (425) 261-2000

1330 Rockefeller Ave
Everett, WA 98201-1677

4112 Harbour Pointe Blvd SW
Suite 100
Mukilteo, WA 98275-5457
Phone (425) 347-6330

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion15
Varicose vein removal11
Leg revascularization (restoring blood flow)20

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD61068288WAMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Washington CurrentSince Aug 13, 2020 Accepting new patients
Pacific Vascular Incorporated CurrentSince Aug 5, 2026 Accepting new patients
Pacific Vascular Incorporated CurrentSince Dec 14, 2021 Accepting new patients
Providence Health & Services- Washington CurrentSince Aug 13, 2020 Accepting new patients
Pacific Vascular Incorporated CurrentSince Dec 14, 2021 Accepting new patients
Pacific Vascular Incorporated CurrentSince Dec 14, 2021 Accepting new patients
Pacific Vascular Incorporated CurrentSince Dec 14, 2021 Accepting new patients
Pacific Vascular Incorporated CurrentSince Dec 14, 2021 Accepting new patients
Pacific Vascular Incorporated CurrentSince Dec 1, 2025 Accepting new patients
Pacific Vascular Incorporated CurrentSince Dec 14, 2021 Accepting new patients
Pacific Vascular Incorporated CurrentSince Dec 14, 2021 Accepting new patients
Pacific Vascular Incorporated CurrentSince Dec 14, 2021 Accepting new patients
Pacific Vascular Incorporated CurrentSince Dec 14, 2021 Accepting new patients
Pacific Vascular Incorporated CurrentSince Dec 14, 2021 Accepting new patients
Pacific Vascular Incorporated CurrentSince Dec 14, 2021 Accepting new patients
Pacific Vascular Incorporated CurrentSince Dec 14, 2021 Accepting new patients
Providence Health & Services-Wa Past Accepting new patients

Locations

1321 Colby Ave
Ofc
Everett, WA 98201
Phone (425) 261-4076

1330 Rockefeller Ave
Ste 520
Everett, WA 98201
Phone (425) 297-5200

4112 Harbour Pointe Blvd SW
Ste 100
Mukilteo, WA 98275
Phone (425) 347-6330

Interoperability endpoints

  • Direct secure messaging: dkim1315152@wm.providencedirect.org

Organizations & group practices 17

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

View all 17

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1366848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631750400000",
    "number": "1639513229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 ROCKEFELLER AVE STE 520",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982011677",
            "telephone_number": "877-644-8346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 ROCKEFELLER AVE STE 520",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982011677",
            "telephone_number": "425-297-5200",
            "fax_number": "425-259-8600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Fruit St",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "02114",
            "country_code": "US",
            "telephone_number": "877-644-8346",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "DANIEL",
        "middle_name": "BYEONGHEUI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-25",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "WA",
            "license": "MD61068288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.