Individual provider Active NPI

Min Ji Kim

  • Nurse Practitioner
  • Raleigh, NC
National Provider Identifier
1902603491
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5021763 Issued in NC
Practice address
3404 Wake Forest Rd Ste 100
Raleigh, NC 27609-7341
Phone
(919) 862-5970
NPI assigned
Mar 3, 2025
Last updated
Mar 3, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5021763 NC Primary

Addresses

Primary practice location

3404 Wake Forest Rd Ste 100
Raleigh, NC 27609-7341

Mailing address

285 Dry Canyon Dr
Wendell, NC 27591-3312

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250619001710 NC Practitioner - Nurse Practitioner 3870004435 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Duke University School of Medicine, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Duke Health Integrated Practice IncGroup PAC ID 8325412737, 3,140 clinicians

Practice addresses (Care Compare)

3404 Wake Forest Rd
Suite 200
Raleigh, NC 27609-7341
Phone (919) 684-8111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Duke Health Integrated Practice, Inc. CurrentSince Jul 1, 2025 Accepting new patients
Duke University Health System, Inc. CurrentSince Jul 1, 2025 Accepting new patients
Duke University Health System, Inc. CurrentSince Jul 1, 2025 Accepting new patients
Duke Health Integrated Practice, Inc CurrentSince Jul 1, 2025 Accepting new patients
Duke University Health System, Inc. Nurse Practitioner Current Accepting new patients
Private Diagnostic Clinic, PLLC PastSince Mar 11, 2025 Accepting new patients

Locations

2301 Erwin Rd
Durham, NC 27705
Phone (919) 668-0289

40 Duke Medicine Cir
Durham, NC 27710
Phone (919) 681-6588

3404 Wake Forest Rd
Ste 100
Raleigh, NC 27609
Phone (919) 876-8225

3404 Wake Forest Rd
Ste 200
Raleigh, NC 27609
Phone (919) 235-0097

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1740960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1902603491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 DRY CANYON DR",
            "city": "WENDELL",
            "state": "NC",
            "postal_code": "275913312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3404 WAKE FOREST RD STE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097341",
            "telephone_number": "919-862-5970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MIN",
        "middle_name": "JI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-03",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5021763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.