NPIMap

Individual provider Active NPI

Hyon Soo Harold Kim, MD

  • Otology & Neurotology Physician
  • Portland, OR
National Provider Identifier
1700924719
Registry record updated Mar 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otology & Neurotology PhysicianTaxonomy code 207YX0901X
License
MD24993 Issued in OR
Practice address
2230 NW Pettygrove St
Ste 120
Portland, OR 97210-2659
Phone
(503) 444-7676
Fax
(971) 319-6647
NPI assigned
Feb 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otology & Neurotology Physician 207YX0901X MD24993 OR Primary

Addresses

Primary practice location

2230 NW Pettygrove St
Ste 120
Portland, OR 97210-2659

Mailing address

2230 NW Pettygrove St
Ste 120
Portland, OR 97210-2659
Phone (503) 444-7676

Other identifiers 1

IdentifierTypeStateIssuer
022701MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071127000213 OR Practitioner - Otolaryngology 7618065780 Reassigns benefits to 2 organizations
Practice locations: Portland, OR

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Albert Einstein College of Medicine of Yeshiva University, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bend Memorial Clinic PCGroup PAC ID 7214936533, 225 clinicians

Practice addresses (Care Compare)

2230 NW Pettygrove St
Suite 120
Portland, OR 97210-2659
Phone (503) 444-7676

815 SW Bond St
Suite 100
Bend, OR 97702-3593
Phone (541) 706-2525

Hospital & facility affiliations

  • Legacy Good Samaritan Medical Center Hospital, Portland, OR, CCN 380017
  • Providence Mission Hospital Hospital, Mission Viejo, CA, CCN 050567
  • Providence Seaside Hospital Hospital, Seaside, OR, CCN 381303
  • Legacy Salmon Creek Medical Center Hospital, Vancouver, WA, CCN 500150

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bend Memorial Clinic PC CurrentSince Dec 1, 2024 Accepting new patients
Bend Memorial Clinic PC CurrentSince Dec 1, 2024 Accepting new patients

Locations

1501 NE Medical Center Dr
Bend, OR 97701
Phone (541) 317-4354

815 SW Bond St
#100
Bend, OR 97702
Phone (541) 706-2525

815 SW Bond St
Bend, OR 97702
Phone (541) 382-4900

Interoperability endpoints

  • Direct secure messaging: harold.kim.1@12838.direct.athenahealth.com
  • Direct secure messaging: hkim22427@directmsg.bmctotalcare.com

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.

Hospital & facility affiliations 7

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": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457308800000",
    "number": "1700924719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2230 NW PETTYGROVE ST",
            "address_2": "STE 120",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102659",
            "telephone_number": "503-444-7676",
            "fax_number": "971-319-6647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 NW PETTYGROVE ST",
            "address_2": "STE 120",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102659",
            "telephone_number": "503-444-7676",
            "fax_number": "971-319-6647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "HYON SOO HAROLD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-02",
        "last_updated": "2016-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "OR",
            "license": "MD24993",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022701",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.