Jessie Kim-Deobald, MD

Primary specialty

SpecialistTaxonomy code 174400000X

Practice address

1530 N 115TH St
Suite 301
Seattle, WA 98133-8411

Phone

(206) 365-5000

Fax

(206) 365-5002

NPI assigned

Sep 15, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Hope Family Medical Clinic, PLLC

  • Primary Care Clinic/Center
  • Edmonds, WA
  • NPI 1033419221
  NPD (past)

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1902902018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 N 115TH ST",
            "address_2": "SUITE 301",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981338411",
            "telephone_number": "206-365-5000",
            "fax_number": "206-365-5002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 N 115TH ST",
            "address_2": "SUITE 301",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981338411",
            "telephone_number": "206-365-5000",
            "fax_number": "206-365-5002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM-DEOBALD",
        "first_name": "JESSIE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-15",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093699",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE RYDER NUMBER",
            "identifier": "5355KI",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamela J. Kiltz, OTR/L
• Kim & Cervantes-Kim DDS PLLC
• Kim Okamura DDS
• Kim S. Mallick, M.D., P.S.
• Lauren Kim Sing, MD
• Sally H. Kim-Miller, M.D.
• Alex Kim, CRNA
• Alexis Jenna Kim
• Amanda Kim, M.D.
• Anastasia Ji Young Kim

• Specialist in Seattle, WA
• Providers in Seattle, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.