Individual provider Active NPI

Hyung Taek Kim, M.D.

  • Emergency Medicine Physician
  • Baltimore, MD
National Provider Identifier
1699711861
Registry record updated Feb 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
D0057354 Issued in MD
Practice address
22 S Greene St
Baltimore, MD 21201-1544
Phone
(410) 328-4383
NPI assigned
Jun 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X D0057354 MD Primary

Addresses

Primary practice location

22 S Greene St
Baltimore, MD 21201-1544

Mailing address

PO Box 73276
Baltimore, MD 21273-3276
Phone (301) 631-8103

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20160222002594 CA Practitioner - Emergency Medicine 1052554706 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0057354MDMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles CurrentSince Feb 15, 2016 Accepting new patients
County of Los Angeles Current Accepting new patients
County of Los Angeles Auditor Controller CurrentSince Feb 15, 2016 Accepting new patients

Locations

14445 Olive View Dr
Sylmar, CA 91342
Phone (881) 836-4303

Organizations & group practices 3

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": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202169600000",
    "number": "1699711861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 73276",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212733276",
            "telephone_number": "301-631-8103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 S GREENE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011544",
            "telephone_number": "410-328-4383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "HYUNG TAEK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2008-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MD",
            "license": "D0057354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.