Individual provider Active NPI

David Yoonsung Kim

  • Anatomic Pathology & Clinical Pathology Physician
  • Tulsa, OK
National Provider Identifier
1760846125
Registry record updated Mar 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
7566 Issued in OK
Practice address
4142 S Mingo Rd
Tulsa, OK 74146-3632
Phone
(918) 744-2553
Fax
(918) 744-3482
NPI assigned
Apr 11, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 7566 OK Primary

Addresses

Primary practice location

4142 S Mingo Rd
Tulsa, OK 74146-3632

Mailing address

4142 S Mingo Rd
Tulsa, OK 74146-3632
Phone (918) 744-2553

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, 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
I20220728002436 OK Practitioner - Pathology 0446632038 Reassigns benefits to 2 organizations
I20220728003532 TX Practitioner - Pathology 0446632038 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Nova Southeastern College of Osteo Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pathology Laboratory Associates, Inc.Group PAC ID 3476539529, 24 clinicians

Practice addresses (Care Compare)

4142 S Mingo Rd
Tulsa, OK 74146-3632
Phone (918) 417-6400

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7566OKMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Pathology Laboratory Associates, Inc. Anatomic Pathology & Clinical Pathology CurrentSince Aug 1, 2022 Accepting new patients
Creek Nation Hospital & Clinics Current Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Aug 1, 2022 Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Aug 1, 2022 Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Aug 1, 2022 Accepting new patients

Locations

900 E Airport Rd
Okmulgee, OK 74447
Phone 91875643334448

1401 Morris Dr
Okmulgee, OK 74447
Phone (918) 456-0641

1125 E Cleveland Ave
Sapulpa, OK 74066
Phone (918) 224-9310

8801 S 101st East Ave
Tulsa, OK 74133
Phone (800) 965-4565

10109 E 79th St
Tulsa, OK 74133
Phone (888) 552-6760

4142 S Mingo Rd
Tulsa, OK 74146
Phone (918) 417-6400

1120 S Utica Ave
Tulsa, OK 74104
Phone (918) 579-6090

Dept 1038
Tulsa, OK 74182

4144 S Mingo Rd
Tulsa, OK 74146
Phone (918) 744-2500

Dept 1050
Tulsa, OK 74182

1923 S Utica Ave
Tulsa, OK 74104
Phone (918) 744-2345

Dept 1467
Tulsa, OK 74182

Interoperability endpoints

  • Direct secure messaging: dkim110927@direct.phhs.org

Organizations & group practices 5

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 9

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": "1460332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711065600000",
    "number": "1760846125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4142 S MINGO RD",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741463632",
            "telephone_number": "918-744-2553",
            "fax_number": "918-744-3482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4142 S MINGO RD",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741463632",
            "telephone_number": "918-744-2553",
            "fax_number": "918-744-3482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "DAVID",
        "middle_name": "YOONSUNG",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-11",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "OK",
            "license": "7566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.