Soon Ja Kim MD PA

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

Legal business name

SOON JA KIM MD PA

Practice address

5808 Main St
Elkridge, MD 21075-5105

Phone

(410) 796-7730

Fax

(410) 379-1537

NPI assigned

Mar 18, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Soon Ja Kim, MDNPI 1023095643

Title

President

Phone

(410) 796-7730

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Soon Ja Kim, MD

  • Family Medicine Physician
  • Elkridge, MD
  • NPI 1023095643
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1268870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271808000000",
    "number": "1669796710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5808 MAIN ST",
            "city": "ELKRIDGE",
            "state": "MD",
            "postal_code": "210755105",
            "telephone_number": "410-796-7730",
            "fax_number": "410-379-1537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5808 MAIN ST",
            "city": "ELKRIDGE",
            "state": "MD",
            "postal_code": "210755105",
            "telephone_number": "410-796-7730",
            "fax_number": "410-379-1537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOON JA KIM MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-18",
        "last_updated": "2010-04-21",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SOON",
        "authorized_official_middle_name": "JA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-796-7730",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "794391100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "010003063",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anne M Smith, RD
• Kirstie Michelle Smith, BCBA
• April Ilene Dacruz Smothers, OTR/L
• Rallie Gilchrist Snowden, LCSW
• Carol Sobon, RPH
• Laura Marder Sorkin, CRNP
• Rachel Carolyn Souza, M.A., BCBA
• Mary Spangler, CRNP
• Specialty Pain Management Services
• Speech Prints

• Adult Medicine Physician in Elkridge, MD
• Providers in Elkridge, MD by specialty
• Adult Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.