Lydia Soo-Hyun Kim

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A125333 Issued in CA

Practice address

US Hwy 491 North
Shiprock, NM 87420

Phone

(505) 368-6001

Fax

(505) 368-7011

NPI assigned

Apr 4, 2011

Last updated

Sep 17, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• DHHS, PHS, Naihs, Shiprock Hospital

  dba Northern Navajo Medical Center

  • General Acute Care Hospital
  • Shiprock, NM
  • NPI 1780639971

  TX

  Medicare reassignment NPD
• County of Los Angeles

  dba Martin Luther King, Jr. Outpatient Center

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1780877613
  Medicare reassignment NPD
• County of Los Angeles

  dba County of Los Angeles Harbor UCLA Medical Center

  • General Acute Care Hospital
  • Torrance, CA
  • NPI 1851363188
  Medicare reassignment NPD
• DHHS, PHS, Naihs, Shiprock Hospital

  dba Northern Navajo Medical Center

  • Ambulatory Surgical Clinic/Center
  • Shiprock, NM
  • NPI 1407039589
  NPD
• County of Los Angeles

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1295407401
  NPD
• County of Los Angeles Auditor Controller

  dba High Desert Regional Health Center

  • Clinic/Center
  • Lancaster, CA
  • NPI 1366453045
  NPD
• DHHS, PHS, Naihs, Shiprock Hospital

  • General Acute Care Hospital
  • Teec Nos Pos, AZ
  • NPI 1477615789
  NPD

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

{
    "created_epoch": "1301875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442448000000",
    "number": "1780973396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160",
            "city": "SHIPROCK",
            "state": "NM",
            "postal_code": "874200160",
            "telephone_number": "505-368-6001",
            "fax_number": "505-368-7011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "US HWY 491 NORTH",
            "city": "SHIPROCK",
            "state": "NM",
            "postal_code": "87420",
            "telephone_number": "505-368-6001",
            "fax_number": "505-368-7011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "LYDIA",
        "middle_name": "SOO-HYUN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-04",
        "last_updated": "2015-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A125333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raymond M Keeswood Jr., LADAC
• Alexia Belle Keith
• Tyrone L Kellewood, MHC
• Harlan Hunt Kelley, MD
• Gwendolyn Kelly
• William H Kim, MD
• Gloria King, LPC, MA
• Joann King, PHN, RN, MSN
• John William King, DDS MSD
• Michael Jon King, RT

• Pediatrics Physician in Shiprock, NM
• Providers in Shiprock, NM by specialty
• Pediatrics Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.