Individual provider Active NPI

Eung Kwon Kim, D.C.

  • Chiropractor
  • Columbia, MD
National Provider Identifier
1871526608
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
S01870 Issued in MD
Practice address
8860 Columbia 100 Pkwy Ste 311
Columbia, MD 21045-2298
Phone
(410) 715-3500
Fax
(410) 715-2115
NPI assigned
Jul 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X S01870 MD Primary

Addresses

Primary practice location

8860 Columbia 100 Pkwy Ste 311
Columbia, MD 21045-2298

Mailing address

8860 Columbia 100 Pkwy Ste 311
Columbia, MD 21045-2298
Phone (410) 715-3500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20051005000834 DC Practitioner - Chiropractic 5496780769 Reassigns benefits to 1 organization
I20240226004004 MD Practitioner - Chiropractic 5496780769 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12230 Rockville Pike
Suite 250
Rockville, MD 20852-1671
Phone (301) 881-1000

8860 Columbia 100 Pkwy
Suite 311
Columbia, MD 21045-2298
Phone (410) 715-3500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
S01870MDMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Kim Chiropractic Clinic, P.a. Chiropractor CurrentSince Sep 22, 2009 Accepting new patients
First Imaging Center Inc CurrentSince Jul 28, 2011 Accepting new patients

Locations

8860 Columbia 100 Pkwy
Ste 311
Columbia, MD 21045
Phone (410) 715-3500

12230 Rockville Pike
Ste 250
Rockville, MD 20852
Phone (301) 468-6515

13880 Braddock Rd
Ste 207
Centreville, VA 20121
Phone (703) 815-2300

Organizations & group practices 2

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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871526608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8860 COLUMBIA 100 PKWY STE 311",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452298",
            "telephone_number": "410-715-3500",
            "fax_number": "410-715-2115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8860 COLUMBIA 100 PKWY STE 311",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452298",
            "telephone_number": "410-715-3500",
            "fax_number": "410-715-2115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "EUNG",
        "middle_name": "KWON",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MD",
            "license": "S01870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.