Active NPI
Hae Kyong Kim Nelson, M.D.
- Pediatrics Physician
- Greenville, SC
National Provider Identifier
1790729218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 20480
- Practice address
- 200 Patewood Dr
Suite A120
Greenville, SC 29615-3593 - Phone
- (864) 454-2670
- Fax
- (864) 454-2679
- NPI assigned
- Jun 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 20480 | SC | Primary |
Addresses
Primary practice location
200 Patewood Dr
Suite A120
Greenville, SC 29615-3593
Mailing address
1 Independence PT
Suite 212
Greenville, SC 29615-4545
Phone (864) 797-6044
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3816691 | Other | SC | CIGNA ID |
| 7744166 | Other | SC | AETNA ID |
| 204807 | Medicaid | SC | |
| 571004971024 | Other | SC | BCBS OF SC ID |
| 571004971027 | Other | SC | BLUECHOICE HEALTHPLAN ID |
| 370017229 | Other | SC | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357603200000",
"number": "1790729218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 INDEPENDENCE PT",
"address_2": "SUITE 212",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296154545",
"telephone_number": "864-797-6044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 PATEWOOD DR",
"address_2": "SUITE A120",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296153593",
"telephone_number": "864-454-2670",
"fax_number": "864-454-2679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "HAE KYONG",
"middle_name": "KIM",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-15",
"last_updated": "2013-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "SC",
"license": "20480",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA ID",
"identifier": "3816691",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA ID",
"identifier": "7744166",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "204807",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF SC ID",
"identifier": "571004971024",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECHOICE HEALTHPLAN ID",
"identifier": "571004971027",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "370017229",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.