Active NPI
Moon C Kim, M.D.
- Anesthesiology Physician
- Mechanicsville, VA
National Provider Identifier
1861480253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 0101029623
- Practice address
- 8260 Atlee Rd
Mechanicsville, VA 23116-1844 - Phone
- (804) 764-6000
- NPI assigned
- Oct 10, 2005
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 0101029623 | VA | Primary |
Addresses
Primary practice location
8260 Atlee Rd
Mechanicsville, VA 23116-1844
Mailing address
5855 Bremo Rd
Suite 100 North
Richmond, VA 23226-1926
Phone (804) 288-6258
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5721032 | Medicaid | VA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101029623 | VA | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196812800000",
"number": "1861480253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5855 BREMO RD",
"address_2": "SUITE 100 NORTH",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232261926",
"telephone_number": "804-288-6258",
"fax_number": "804-282-9921"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8260 ATLEE RD",
"city": "MECHANICSVILLE",
"state": "VA",
"postal_code": "231161844",
"telephone_number": "804-764-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MOON",
"middle_name": "C",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-10",
"last_updated": "2007-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "VA",
"license": "0101029623",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5721032",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Mechanicsville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.