NPIMap

Individual provider Active NPI

Brandon J Kim, DPM

  • Primary Podiatric Medicine Podiatrist
  • Phoenix, AZ
National Provider Identifier
1962496323
Registry record updated Oct 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X
License
00571 Issued in AZ
Practice address
1002 E McDowell Rd
Suite a
Phoenix, AZ 85006-2625
Phone
(602) 262-2663
Fax
(602) 258-3008
NPI assigned
Aug 31, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Podiatric Medicine Podiatrist 213EP1101X 00571 AZ Primary

Addresses

Primary practice location

1002 E McDowell Rd
Suite a
Phoenix, AZ 85006-2625

Mailing address

1002 E McDowell Rd
Suite a
Phoenix, AZ 85006-2625
Phone (602) 262-2663

Other identifiers 2

IdentifierTypeStateIssuer
Z84078OtherAZMEDICARE ID-PIN
797897MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
00571AZMDPrimary Podiatric Medicine Podiatrist
571AZMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Simplicity Health LLC Current Accepting new patients
Footcare Center - Dr. Mark Gorman, PC Past Accepting new patients
Elite Foot and Ankle Surgical Specialists Primary Podiatric Medicine PastSince Oct 4, 2004 Accepting new patients
Pueblo Family Physicians LTD Past Accepting new patients

Organizations & group practices 4

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": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191283200000",
    "number": "1962496323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 E MCDOWELL RD",
            "address_2": "SUITE A",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062625",
            "telephone_number": "602-262-2663",
            "fax_number": "602-258-3008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 E MCDOWELL RD",
            "address_2": "SUITE A",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062625",
            "telephone_number": "602-262-2663",
            "fax_number": "602-258-3008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "BRANDON",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-31",
        "last_updated": "2007-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "AZ",
            "license": "00571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-PIN",
            "identifier": "Z84078",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "797897",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2007; 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.