Active NPI
Jason Kim
- Community Health Worker
- Fairbanks, AK
National Provider Identifier
1659900942
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 1825 Marika Rd
Fairbanks, AK 99709-5521 - Phone
- (907) 474-0890
- NPI assigned
- Apr 7, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Day Training/Habilitation Specialist | 373H00000X | |||
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
1825 Marika Rd
Fairbanks, AK 99709-5521
Mailing address
1825 Marika Rd
Fairbanks, AK 99709-5521
Phone (907) 474-0890
Other practice location 1
7521 Brayton Dr
Anchorage, AK 99507-2667
Phone (907) 929-5826
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| N.A | Other | AK | N.A |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Anchorage | ||
| Other URL | Fairbanks |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614816000000",
"number": "1659900942",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1825 MARIKA RD",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997095521",
"telephone_number": "907-474-0890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1825 MARIKA RD",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997095521",
"telephone_number": "907-474-0890"
}
],
"practiceLocations": [
{
"address_1": "7521 Brayton Dr",
"address_purpose": "LOCATION",
"city": "Anchorage",
"state": "AK",
"postal_code": "995072667",
"country_code": "US",
"telephone_number": "907-929-5826",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "JASON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-04-07",
"last_updated": "2021-03-04",
"certification_date": "2021-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "373H00000X",
"taxonomy_group": "",
"desc": "Day Training/Habilitation Specialist",
"state": null,
"license": null,
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "N.A",
"identifier": "N.A",
"state": "AK"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Anchorage",
"affiliation": "N",
"address_1": "7521 Brayton Dr",
"city": "Anchorage",
"state": "AK",
"country_code": "US",
"postal_code": "995072667",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Fairbanks",
"affiliation": "N",
"address_1": "1825 Marika Rd",
"city": "Fairbanks",
"state": "AK",
"country_code": "US",
"postal_code": "997095521",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.