Individual provider Active NPI

Stephen S Kim, MD

  • Internal Medicine Physician
  • Vancouver, WA
National Provider Identifier
1740226893
Registry record updated Jun 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD00033818 Issued in WA
Practice address
222 NE Park Plaza Dr
Suite 100
Vancouver, WA 98684-5895
Phone
(360) 254-8025
Fax
(360) 254-8618
NPI assigned
Jun 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD00033818 WA Primary

Addresses

Primary practice location

222 NE Park Plaza Dr
Suite 100
Vancouver, WA 98684-5895

Mailing address

222 NE Park Plaza Dr
Suite 100
Vancouver, WA 98684-5895
Phone (360) 254-8025

Other identifiers 2

IdentifierTypeStateIssuer
110146504OtherWARAILROAD MEDICARE
8204026MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20170512002046 AZ Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 4284766833

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214265600000",
    "number": "1740226893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 NE PARK PLAZA DR",
            "address_2": "SUITE 100",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986845895",
            "telephone_number": "360-254-8025",
            "fax_number": "360-254-8618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 NE PARK PLAZA DR",
            "address_2": "SUITE 100",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986845895",
            "telephone_number": "360-254-8025",
            "fax_number": "360-254-8618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "STEPHEN",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2008-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00033818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110146504",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8204026",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.