Individual provider Active NPI

Jin Kyu Kim, MD

  • Urology Physician
  • Indianapolis, IN
National Provider Identifier
1831935923
Registry record updated Aug 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
01097418A Issued in IN
Practice address
705 Riley Hospital Dr
Indianapolis, IN 46202-5109
Phone
(905) 746-8973
NPI assigned
Jul 8, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2088P0231X 11023895A IN
Urology Physician 208800000X 01097418A IN Primary

Addresses

Primary practice location

705 Riley Hospital Dr
Indianapolis, IN 46202-5109

Mailing address

PO Box 719094
Chicago, IL 60677-9318
Phone (317) 777-6435

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20240715003324 IN Order and Referring Only - UrologyPractitioner - Urology 8921543844

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11023895AINMDPediatric Urology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Iu Health Medical Group Riley Specialists, LLC Single Specialty Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1720396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785974400000",
    "number": "1831935923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 719094",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606779318",
            "telephone_number": "317-777-6435",
            "fax_number": "317-777-6644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 RILEY HOSPITAL DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025109",
            "telephone_number": "905-746-8973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JIN KYU",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-07-08",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2088P0231X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology, Pediatric Urology",
            "state": "IN",
            "license": "11023895A",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IN",
            "license": "01097418A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.