Miyong Kim, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95010459 Issued in CA

Practice address

9040 Jackson Ave
Tacoma, WA 98431-5108

Phone

(253) 968-1110

NPI assigned

Mar 26, 2019

Last updated

Mar 17, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Prudent Medical Providers NW

  dba N/a

  • Family Medicine Physician
  • Federal Way, WA
  • NPI 1699364455
  Medicare reassignment NPD
• Korean Health, Education, Information and Research Center

  • Primary Care Clinic/Center
  • Los Angeles, CA
  • NPI 1013311448
  NPD (past)

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

{
    "created_epoch": "1553558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647475200000",
    "number": "1790246478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3663 W 4TH ST UNIT 10",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900202335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040 JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984315108",
            "telephone_number": "253-968-1110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3255 Wilshire Blvd Ste 120",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900101405",
            "country_code": "US",
            "telephone_number": "213-235-2500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3727 W 6th St Ste 210",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900205108",
            "country_code": "US",
            "telephone_number": "213-235-1203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "MIYONG",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-26",
        "last_updated": "2022-03-17",
        "certification_date": "2022-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95010459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew J. Kim, M.D.
• Michael Jinwoo Kim, PHARM D
• Mike Y Kim, DDS
• Min Sun Kim, OTR/L
• Mira Kim, PHARMD
• Mukhui Kim, AEMP
• Museong Kim, NP
• Nam Su Kim
• Paul Kim, M.D.
• Rachel Kim

• Family Nurse Practitioner in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2022; 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.