Ducksoo Kim, MD

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

License

41575 Issued in MA

Practice address

1400 VFW Pkwy
West Roxbury, MA 02132-4927

Phone

(857) 203-6414

NPI assigned

May 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686009600000",
    "number": "1922055326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CEDAR HILL RD",
            "city": "DOVER",
            "state": "MA",
            "postal_code": "020301631",
            "telephone_number": "508-395-3110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 VFW PKWY",
            "city": "WEST ROXBURY",
            "state": "MA",
            "postal_code": "021324927",
            "telephone_number": "857-203-6414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "DUCKSOO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MA",
            "license": "41575",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "MA",
            "license": "41575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6171095",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Catherine Ann Kelly, PT, DPT, MS
• Justin C Kelly
• Meagan Kelly, NP-C
• James E Kelsey
• Babak Khademi, M.D.
• Joseph Kim, DPT
• NA Hyun Kim
• Cassandra Chang King
• Krysta Lynn Kingsbury, OTR/L
• Scott Kinlay, MBBS PHD

• Vascular & Interventional Radiology Physician in West Roxbury, MA
• Providers in West Roxbury, MA by specialty
• Vascular & Interventional Radiology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.