Individual provider Active NPI

Charles K Kim, MD

  • Family Medicine Physician
  • Dallas, TX
National Provider Identifier
1700854411
Registry record updated Jul 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
48293 Issued in MN
Practice address
325 N Saint Paul St Ste 3100
Dallas, TX 75201-3923
Phone
(617) 505-1520
Fax
(617) 928-8401
NPI assigned
Mar 9, 2006
Last updated
Jul 17, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 48293 MN Primary
Family Medicine Physician 207Q00000X U3103 TX

Addresses

Primary practice location

325 N Saint Paul St Ste 3100
Dallas, TX 75201-3923

Mailing address

109 State St Ste 5
Boston, MA 02109-2906
Phone (617) 505-1520

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, TX2 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
I20060125000280 MN Practitioner - Family Practice 1850353814
I20260616004833 TX Practitioner - Family Practice 1850353814 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1914 Ashland Ave
Saint Paul, MN 55104-5947

4400 Bayou Blvd
Suite 32B
Pensacola, FL 32503-1903

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Minnesota CurrentSince Jan 7, 2008 Accepting new patients
Regents of the University of Minnesota Current Accepting new patients
Regents of the University of Minnesota CurrentSince Jan 7, 2008 Accepting new patients
North Memorial Health Care Past Accepting new patients
Toh Inc PastSince Feb 21, 2000 Accepting new patients
North Memorial Health Care Past Accepting new patients

Locations

410 Church St SE
Minneapolis, MN 55455
Phone (612) 625-8400

410 Church St SE
#W235
Minneapolis, MN 55455

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784246400000",
    "number": "1700854411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 STATE ST STE 5",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021092906",
            "telephone_number": "617-505-1520",
            "fax_number": "617-928-8401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 N SAINT PAUL ST STE 3100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752013923",
            "telephone_number": "617-505-1520",
            "fax_number": "617-928-8401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHARLES",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2026-07-17",
        "certification_date": "2026-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "48293",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "U3103",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.