Individual provider Active NPI

Brian Jung Hun Kim, M.D.

  • Diagnostic Radiology Physician
  • Dallas, TX
National Provider Identifier
1669558367
Registry record updated Sep 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
A74367 Issued in CA
Practice address
2825 Oak Lawn Ave Unit 192749
Dallas, TX 75219-4688
Phone
(844) 389-5711
Fax
(877) 880-2039
NPI assigned
Oct 27, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X R9632 TX
Diagnostic Radiology Physician 2085R0202X A74367 CA Primary

Addresses

Primary practice location

2825 Oak Lawn Ave Unit 192749
Dallas, TX 75219-4688

Mailing address

2825 Oak Lawn Ave Unit 192749
Dallas, TX 75219-4688
Phone (844) 389-5711

Other practice location 1

1509 Wilson Ter
Glendale, CA 91206-4007
Phone (818) 409-8010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A74367CAMDDiagnostic Radiology Physician
R9632TXMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Radiology Chartered Diagnostic Radiology CurrentSince Jan 4, 2024 Accepting new patients
Cira Michigan PC Diagnostic Radiology Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Glendale Radiology Medical Group, Inc. Diagnostic Radiology Past Accepting new patients
MRI Imaging Institute Diagnostic Radiology Past Accepting new patients
Johns Hopkins University Diagnostic Radiology Past Accepting new patients
Summit Radiology P C Diagnostic Radiology Past Accepting new patients
New Castle Clinic Inc Diagnostic Radiology Past Accepting new patients
Imaging Diagnostic Center Limited Diagnostic Radiology Past Accepting new patients

Locations

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

1789 Shawano Ave
Green Bay, WI 54303

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1669558367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 OAK LAWN AVE UNIT 192749",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752194688",
            "telephone_number": "844-389-5711",
            "fax_number": "877-880-2039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 OAK LAWN AVE UNIT 192749",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752194688",
            "telephone_number": "844-389-5711",
            "fax_number": "877-880-2039"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1509 Wilson Ter",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "CA",
            "postal_code": "912064007",
            "country_code": "US",
            "telephone_number": "818-409-8010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "BRIAN",
        "middle_name": "JUNG HUN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "R9632",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A74367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.