Active NPI
Youngki Kim, M
- Pediatric Nephrology Physician
- Minneapolis, MN
National Provider Identifier
1689764144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nephrology Physician
- License
- 22048
- Practice address
- 516 Delaware St SE
PWB 4TH Floor, Room 4-100
Minneapolis, MN 55455-0356 - Phone
- (612) 626-6777
- NPI assigned
- Oct 13, 2006
- Last updated
- Oct 26, 2012
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 22048 | MN | |
| Pediatric Nephrology Physician | 2080P0210X | 22048 | MN | Primary |
Addresses
Primary practice location
516 Delaware St SE
PWB 4TH Floor, Room 4-100
Minneapolis, MN 55455-0356
Mailing address
420 Delaware St SE MMC 491
University of Minnesota Physicians
Minneapolis, MN 55455
Phone (612) 626-6777
Other identifiers 17
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 053926 | Other | MN | FAIRVIEW |
| 2104458 | Medicaid | OH | |
| 3107051 | Other | MN | MEDICA-CHOICE |
| 7777470 | Medicaid | SD | |
| 64421308 | Medicaid | KY | |
| 1012191 | Other | MN | PREFERRED ONE |
| 10387 | Medicaid | ND | |
| A063 | Other | CHAMPUS/TRIWEST | |
| 768197 | Other | ARAZ | |
| 0012087 | Medicaid | MT | |
| 0990457 | Medicaid | IA | |
| 101068 | Other | MN | U CARE |
| 2T291KI | Other | MN | BCBS |
| 30200800 | Medicaid | WI | |
| 3107051 | Other | MN | MEDICA-PRIMARY |
| 685883000 | Medicaid | MN | |
| HP21987 | Other | MN | HEALTH PARTNERS |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Minnesota Physicians | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Multi-Specialty Clinic/Center
- Minneapolis, MN
- NPI 1477598118
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351209600000",
"number": "1689764144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 DELAWARE ST SE MMC 491",
"address_2": "UNIVERSITY OF MINNESOTA PHYSICIANS",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55455",
"telephone_number": "612-626-6777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "516 DELAWARE ST SE",
"address_2": "PWB 4TH FLOOR, ROOM 4-100",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550356",
"telephone_number": "612-626-6777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "YOUNGKI",
"credential": "M",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-13",
"last_updated": "2012-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "22048",
"primary": false
},
{
"code": "2080P0210X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Nephrology",
"state": "MN",
"license": "22048",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FAIRVIEW",
"identifier": "053926",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2104458",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA-CHOICE",
"identifier": "3107051",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7777470",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64421308",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1012191",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10387",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS/TRIWEST",
"identifier": "A063",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARAZ",
"identifier": "768197",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0012087",
"state": "MT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0990457",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "U CARE",
"identifier": "101068",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "2T291KI",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30200800",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA-PRIMARY",
"identifier": "3107051",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "685883000",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP21987",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.