Individual provider Active NPI

Dong-Young Kim, FNP

  • Family Nurse Practitioner
  • Fallon, NV
National Provider Identifier
1912414731
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
823622 Issued in NV
Practice address
801 E Williams Ave Ste &2207
Fallon, NV 89406-3052
Phone
(775) 867-7740
NPI assigned
Jan 2, 2018
Last updated
Sep 15, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 823622 NV Primary

Addresses

Primary practice location

801 E Williams Ave Ste &2207
Fallon, NV 89406-3052

Mailing address

801 E Williams Ave Ste &2207
Fallon, NV 89406-3052
Phone (775) 867-7740

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NV2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200103001866 TX Practitioner - Nurse Practitioner 5496017394 Reassigns benefits to 1 organization
I20230719002477 NV Practitioner - Nurse Practitioner 5496017394 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

801 E Williams Ave
Fallon, NV 89406-3052

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
823622NVMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fallon Tribal Health Center CurrentSince Nov 21, 2019 Accepting new patients
Banner Churchill Community Hospital CurrentSince Aug 1, 2023 Accepting new patients

Locations

1001 Rio Vista Dr
Fallon, NV 89406
Phone (775) 423-3634

801 E Williams Ave
Fallon, NV 89406
Phone (775) 423-0310

801 E Williams Ave
Ste 2207
Fallon, NV 89406
Phone (775) 867-7701

Interoperability endpoints

  • Direct secure messaging: dkim@fthc.directbygreenway.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1514851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757894400000",
    "number": "1912414731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 E WILLIAMS AVE STE &2207",
            "city": "FALLON",
            "state": "NV",
            "postal_code": "894063052",
            "telephone_number": "775-867-7740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E WILLIAMS AVE STE &2207",
            "city": "FALLON",
            "state": "NV",
            "postal_code": "894063052",
            "telephone_number": "775-867-7740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "DONG-YOUNG",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-02",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NV",
            "license": "823622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fallon, NV

Sources for this page

Verify at the official NPI Registry.