Individual provider Active NPI

Paul Kim

  • Diagnostic Radiology Physician
  • Trinity, FL
National Provider Identifier
1770112898
Registry record updated Jun 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
0102209156 Issued in VA
Practice address
9330 State Road 54
Trinity, FL 34655-1808
Phone
(727) 834-4832
Fax
(727) 816-2463
NPI assigned
Apr 2, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 0102209156 VA Primary

Addresses

Primary practice location

9330 State Road 54
Trinity, FL 34655-1808

Mailing address

9330 State Road 54
Trinity, FL 34655-1808
Phone (727) 834-4832

Other practice location 1

1250 E Marshall St
Richmond, VA 23298-5023
Phone (804) 828-6600

Other practice location 2

300 Mt Clement Park
Tappahannock, VA 22560-5098
Phone (804) 828-6600

Other practice location 3

618 Hospital Rd
Tappahannock, VA 22560-5000
Phone (804) 828-6600

Other practice location 4

1001 E Leigh St
Richmond, VA 23298-5004
Phone (804) 628-7245

Other practice location 5

9000 Stony Point Pkwy
Richmond, VA 23235-1900
Phone (804) 560-8906

Other practice location 6

1213 E Clay St
Richmond, VA 23298-5071
Phone (804) 828-6600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20250902003831 VA Practitioner - Diagnostic Radiology 3072939958 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Nova Southeastern College of Osteo Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCV Associated PhysiciansGroup PAC ID 4385542117, 1,779 clinicians

Practice addresses (Care Compare)

1250 E Marshall St
Richmond, VA 23219-5051
Phone (804) 828-9000

Hospital & facility affiliations

  • Medical College of Virginia Hospitals Hospital, Richmond, VA, CCN 490032
  • Vcu Health Tappahannock Hospital Hospital, Tappahannock, VA, CCN 490084

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0102209156VAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCV Associated Physicians Diagnostic Radiology CurrentSince Jul 1, 2025 Accepting new patients

Locations

9000 Stony Point Pkwy
Richmond, VA 23235
Phone (804) 560-8906

1250 E Marshall St
Richmond, VA 23298
Phone (804) 628-6990

1001 E Leigh St
Richmond, VA 23298
Phone (804) 628-7497

401 N 11th St
Richmond, VA 23219
Phone (804) 828-4409

1213 E Clay St
Richmond, VA 23298
Phone (804) 827-1207

618 Hospital Rd
Tappahannock, VA 22560
Phone (804) 443-3311

300 Mt Clement Park
Tappahannock, VA 22560
Phone (804) 443-6063

Organizations & group practices 1

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 3

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": "1585785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748995200000",
    "number": "1770112898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9330 STATE ROAD 54",
            "city": "TRINITY",
            "state": "FL",
            "postal_code": "346551808",
            "telephone_number": "727-834-4832",
            "fax_number": "727-816-2463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9330 STATE ROAD 54",
            "city": "TRINITY",
            "state": "FL",
            "postal_code": "346551808",
            "telephone_number": "727-834-4832",
            "fax_number": "727-816-2463"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1250 E Marshall St",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232985023",
            "country_code": "US",
            "telephone_number": "804-828-6600",
            "fax_number": "804-828-6129",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Mt Clement Park",
            "address_purpose": "LOCATION",
            "city": "Tappahannock",
            "state": "VA",
            "postal_code": "225605098",
            "country_code": "US",
            "telephone_number": "804-828-6600",
            "fax_number": "804-828-6129",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "618 Hospital Rd",
            "address_purpose": "LOCATION",
            "city": "Tappahannock",
            "state": "VA",
            "postal_code": "225605000",
            "country_code": "US",
            "telephone_number": "804-828-6600",
            "fax_number": "804-828-6129",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1001 E Leigh St",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232985004",
            "country_code": "US",
            "telephone_number": "804-628-7245",
            "fax_number": "804-828-6129",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9000 Stony Point Pkwy",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232351900",
            "country_code": "US",
            "telephone_number": "804-560-8906",
            "fax_number": "804-237-6618",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1213 E Clay St",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232985071",
            "country_code": "US",
            "telephone_number": "804-828-6600",
            "fax_number": "804-828-6129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "PAUL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-02",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0102209156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trinity, FL

Sources for this page

Verify at the official NPI Registry.