Individual provider Active NPI

Mina Soon Kim, MD

  • Anesthesiology Physician
  • North Kansas City, MO
National Provider Identifier
1780975417
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
C1-0011319 Issued in DE
Practice address
2700 Clay Edwards Dr Ste 240
North Kansas City, MO 64116-3254
Phone
(816) 691-2021
Fax
(816) 346-7690
NPI assigned
Apr 28, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 2023011513 MO
Student in an Organized Health Care Education/Training Program 390200000X
Anesthesiology Physician 207L00000X C1-0011319 DE Primary

Addresses

Primary practice location

2700 Clay Edwards Dr Ste 240
North Kansas City, MO 64116-3254

Mailing address

9411 N Oak Trfy Ste LL1
Kansas City, MO 64155-2262
Phone (816) 691-1655

Other practice location 1

4755 Ogletown-Stanton Road
Newark, DE 19718
Phone (302) 733-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE, MO2 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
I20150804003367 DE Practitioner - Anesthesiology 5294966362 Reassigns benefits to 1 organization
I20230719000661 MO Practitioner - Anesthesiology 5294966362 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Meritas Health CorporationGroup PAC ID 6305748153, 492 clinicians

Practice addresses (Care Compare)

2700 Clay Edwards Dr
Suite 240
North Kansas City, MO 64116-3254
Phone (816) 691-2021

Hospital & facility affiliations

  • NKC Health Hospital, North Kansas City, MO, CCN 260096

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2023011513MOMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Meritas Health Corporation CurrentSince Aug 1, 2023 Accepting new patients
Anesthesia Services PA Anesthesiology CurrentSince Aug 3, 2015 Accepting new patients
Meritas Health Corporation Anesthesiology CurrentSince Aug 1, 2023 Accepting new patients
Meritas Health Corporation Current Accepting new patients
Meritas Health Corporation Past Accepting new patients
Meritas Health Corporation Past Accepting new patients

Locations

2 Reads Way
Ste 201
New Castle, DE 19720
Phone (302) 709-4504

4755 Ogletownstanton Rd
Newark, DE 19718
Phone (302) 733-6510

2600 Glasgow Ave
Ste 226
Newark, DE 19702
Phone (302) 836-3539

9411 N Oak Trfy
Ste LL1
Kansas City, MO 64155
Phone (816) 436-7072

2700 Clay Edwards Dr
Ste 240
North Kansas City, MO 64116
Phone (816) 455-0681

Organizations & group practices 6

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 2

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": "1303948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1780975417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9411 N OAK TRFY STE LL1",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641552262",
            "telephone_number": "816-691-1655",
            "fax_number": "816-436-2743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 CLAY EDWARDS DR STE 240",
            "city": "NORTH KANSAS CITY",
            "state": "MO",
            "postal_code": "641163254",
            "telephone_number": "816-691-2021",
            "fax_number": "816-346-7690"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4755 Ogletown-Stanton Road",
            "address_purpose": "LOCATION",
            "city": "Newark",
            "state": "DE",
            "postal_code": "19718",
            "country_code": "US",
            "telephone_number": "302-733-1000",
            "fax_number": "215-955-0677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "MINA",
        "middle_name": "SOON",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-28",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "2023011513",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "DE",
            "license": "C1-0011319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Kansas City, MO

Sources for this page

Verify at the official NPI Registry.