NPIMap

Organization Active NPI

Jong Kim Family Medicine

  • Family Medicine Physician
  • Merrillville, IN
National Provider Identifier
1821273962
Registry record updated Jan 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01036861A Issued in IN
Legal business name
JONG KIM FAMILY MEDICINE
Practice address
8777 Broadway
Suite C
Merrillville, IN 46410-6693
Phone
(219) 738-3550
Fax
(219) 757-6727
NPI assigned
Jan 8, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2009

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

Authorized official

Name
Dr. Jong H Kim, M.D.
Title
Owner
Phone
(219) 738-3550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 01036861A IN Primary

Addresses

Primary practice location

8777 Broadway
Suite C
Merrillville, IN 46410-6693

Mailing address

8777 Broadway
Suite C
Merrillville, IN 46410-6693
Phone (219) 738-3550

Other identifiers 1

IdentifierTypeStateIssuer
100200870MedicaidIN

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1199750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231891200000",
    "number": "1821273962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8777 BROADWAY",
            "address_2": "SUITE C",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464106693",
            "telephone_number": "219-738-3550",
            "fax_number": "219-757-6727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8777 BROADWAY",
            "address_2": "SUITE C",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464106693",
            "telephone_number": "219-738-3550",
            "fax_number": "219-757-6727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JONG KIM FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-08",
        "last_updated": "2009-01-14",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JONG",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-738-3550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01036861A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100200870",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Merrillville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.