Individual provider Active NPI

Eugene Young Kim, M.D.

  • Diagnostic Radiology Physician
  • Salt Lake City, UT
National Provider Identifier
1669738696
Registry record updated Jun 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
10731989-1205 Issued in UT
Practice address
30 N 1900 E # 1A71
Salt Lake City, UT 84132-0002
Phone
(801) 213-4262
NPI assigned
Apr 3, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 23, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Diagnostic Radiology Physician 2085R0202X 10731989-1205 UT Primary

Addresses

Primary practice location

30 N 1900 E # 1A71
Salt Lake City, UT 84132-0002

Mailing address

30 N 1900 E # 1A71
Salt Lake City, UT 84132-0002

Other practice location 1

1275 York Ave
New York, NY 10065
Phone (212) 639-2190

Other identifiers 1

IdentifierTypeStateIssuer
286468OtherNYNEW YORK STATE MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, ID2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20181024002681 UT Practitioner - Diagnostic Radiology 0345479408 Reassigns benefits to 2 organizations
I20231218001964 ID Practitioner - Diagnostic Radiology 0345479408 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of California, San Francisco School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

1380 E Medical Ctr Dr
St George, UT 84790-2123
Phone (435) 251-1000

5121 S Cottonwood St
Murray, UT 84107-5701

Hospital & facility affiliations

  • Intermountain Medical Center Hospital, Murray, UT, CCN 460010
  • Intermountain Health Alta View Hospital Hospital, Sandy, UT, CCN 460044
  • Intermountain Health Riverton Hospital Hospital, Riverton, UT, CCN 460058
  • LDS Hospital Hospital, Salt Lake City, UT, CCN 460006
  • Intermountain Health McKay-Dee Hospital Hospital, Ogden, UT, CCN 460004

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10731989-1205UTMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc Family Medicine Current Accepting new patients
University of Utah Adult Services Diagnostic Radiology CurrentSince Aug 15, 2018 Accepting new patients
Tellica Imaging, LLC Diagnostic Radiology CurrentSince Nov 16, 2023 Accepting new patients
Ihc Health Services, Inc. CurrentSince Jan 12, 2024 Accepting new patients
Tellica Imaging, LLC CurrentSince Feb 21, 2022 Accepting new patients
Tellica Imaging, LLC CurrentSince Nov 16, 2023 Accepting new patients
Tellica Imaging, LLC CurrentSince Apr 13, 2023 Accepting new patients
University of Utah Adult Services CurrentSince Aug 15, 2018 Accepting new patients
Ihc Health Services Inc CurrentSince Nov 1, 2020 Accepting new patients
University of Utah Adult Services Current Accepting new patients
Tellica Imaging, LLC CurrentSince Feb 21, 2022 Accepting new patients
Ihc Health Services, Inc. CurrentSince Nov 1, 2020 Accepting new patients

Locations

8505 W Overland Rd
Boise, ID 83709
Phone (208) 417-5100

5444 S Green St
Salt Lake City, UT 84123
Phone (801) 262-2647

5217 S State St
Salt Lake City, UT 84107
Phone (801) 313-4110

36 S Street St
Ste 2200
Salt Lake Cty, UT 84111
Phone (385) 622-0669

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355

1380 E Medical Center Dr
St George, UT 84790
Phone (435) 251-2992

Organizations & group practices 12

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.

Hospital & facility affiliations 5

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": "1333411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592870400000",
    "number": "1669738696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 N 1900 E # 1A71",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N 1900 E # 1A71",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320002",
            "telephone_number": "801-213-4262"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1275 York Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "10065",
            "country_code": "US",
            "telephone_number": "212-639-2190",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "EUGENE",
        "middle_name": "YOUNG",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-03",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "10731989-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW YORK STATE MEDICAL LICENSE",
            "identifier": "286468",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.