Individual provider Active NPI

Isaac Kihoon Kim, MD

  • Internal Medicine Physician
  • Portland, OR
National Provider Identifier
1801243530
Registry record updated Nov 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD191584 Issued in OR
Practice address
4805 NE Glisan St
Portland, OR 97213-2933
Phone
(503) 215-2392
NPI assigned
May 23, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X PG177300 OR
Internal Medicine Physician 207R00000X MD191584 OR Primary

Addresses

Primary practice location

4805 NE Glisan St
Portland, OR 97213-2933

Mailing address

PO Box 3158
Portland, OR 97208-3158

Other practice location 1

5050 NE Hoyt St
Ste 540
Portland, OR 97213-2991
Phone (503) 215-6600

Electronic endpoints 5

TypeEndpointUseAffiliation
Direct Messaging Address ikim600369@oc.providencedirect.org
Direct Messaging Address ikim600369@oc.providencedirect.org
Direct Messaging Address ikim600369@oc.providencedirect.org
Direct Messaging Address ikim600369@oc.providencedirect.org
Direct Messaging Address ikim600369@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20190607000492 OR Practitioner - Internal MedicinePractitioner - Hospitalist 9335431824 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Loma Linda University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services OregonGroup PAC ID 0648183608, 1,423 clinicians
Providence Health and Services - OregonGroup PAC ID 5395656284, 195 clinicians

Practice addresses (Care Compare)

10150 SE 32ND Ave
Milwaukie, OR 97222-6516
Phone (503) 513-3613

4805 NE Glisan St
Portland, OR 97213-2933

5050 NE Hoyt St
Suite 240
Portland, OR 97213-2981
Phone (503) 215-6480

9290 SE Sunnybrook Blvd
Suite 120
Clackamas, OR 97015-6802
Phone (503) 215-2110

Hospital & facility affiliations

  • Providence Portland Medical Center Hospital, Portland, OR, CCN 380061
  • Providence Seaside Hospital Hospital, Seaside, OR, CCN 381303

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince Jul 1, 2019 Accepting new patients
Providence Health & Services Oregon CurrentSince Jul 1, 2019 Accepting new patients
Providence Health & Services - Oregon Internal Medicine Current Accepting new patients
Providence Health & Services Oregon CurrentSince Jul 1, 2019 Accepting new patients
Providence Health & Services Oregon CurrentSince Jun 1, 2022 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon Internal Medicine CurrentSince Sep 1, 2021 Accepting new patients
Providence Health & Services - Oregon Internal Medicine CurrentSince Sep 1, 2021 Accepting new patients
Providence Health & Services - Oregon Current Accepting new patients
Providence Health & Services - Oregon Internal Medicine CurrentSince Jul 1, 2019 Accepting new patients
Providence Health & Services Oregon Internal Medicine Current Accepting new patients

Locations

9290 SE Sunnybrook Blvd
Ste 210
Clackamas, OR 97015
Phone (503) 216-7960

810 12th St
Hood River, OR 97031
Phone (541) 386-3911

1111 Crater Lake Ave
Medford, OR 97504
Phone (541) 732-5250

1003 N Providence Dr
Ste 325
Newberg, OR 97132
Phone (503) 216-1661

1001 N Providence Dr
Newberg, OR 97132
Phone (503) 216-1538

1500 Division St
Oregon City, OR 97045
Phone (503) 646-1631

4805 NE Glisan St
Ste BG5
Portland, OR 97213
Phone (503) 215-2392

10150 SE 32nd Ave
Portland, OR 97222
Phone (503) 215-4202

5050 NE Hoyt St
Ste 540
Portland, OR 97213
Phone (503) 215-6600

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

5050 NE Hoyt St
Ste 240
Portland, OR 97213
Phone (503) 215-6480

Interoperability endpoints

  • Direct secure messaging: ikim600369@oc.providencedirect.org

Organizations & group practices 11

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": "1463961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1801243530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132933",
            "telephone_number": "503-215-2392"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5050 NE Hoyt St",
            "address_2": "STE 540",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972132991",
            "country_code": "US",
            "telephone_number": "503-215-6600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "ISAAC",
        "middle_name": "KIHOON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-23",
        "last_updated": "2021-11-29",
        "certification_date": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OR",
            "license": "PG177300",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD191584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ikim600369@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1001 N Providence Dr",
            "city": "Newberg",
            "state": "OR",
            "country_code": "US",
            "postal_code": "971327485",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ikim600369@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "10150 SE 32nd Ave",
            "city": "Milwaukie",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972226516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ikim600369@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1111 Crater Lake Ave",
            "city": "Medford",
            "state": "OR",
            "country_code": "US",
            "postal_code": "975046241",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ikim600369@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1500 Division St",
            "city": "Oregon City",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970451527",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ikim600369@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "4805 NE Glisan St Ste Bg05",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972132933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.