Individual provider Active NPI

Woo Chul Kim, ARNP, DC

  • Family Nurse Practitioner
  • Everett, WA
National Provider Identifier
1962695528
Registry record updated Oct 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP60673254 Issued in WA
Practice address
3927 Rucker Ave
Everett, WA 98201-4833
Phone
(425) 339-5422
Fax
(425) 339-5444
NPI assigned
Aug 27, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH00034802 WA
Family Nurse Practitioner 363LF0000X AP60673254 WA Primary

Addresses

Primary practice location

3927 Rucker Ave
Everett, WA 98201-4833

Mailing address

7520 Totem Beach Rd
Tulalip, WA 98271-6160
Phone (607) 164-5113

Other practice location 1

7520 Totem Beach Rd
Tulalip, WA 98271-6160
Phone (607) 164-5113

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, TX2 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
I20160922001168 WA Practitioner - Nurse Practitioner 2668769498 Reassigns benefits to 2 organizations
I20211229002158 TX Practitioner - Nurse Practitioner 2668769498 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tulalip Tribes of WashingtonGroup PAC ID 7719879782, 24 clinicians

Practice addresses (Care Compare)

7520 Totem Beach Rd
Tulalip, WA 98271-6160
Phone (360) 716-4511

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CH00034802WAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Feb 5, 2017 Accepting new patients
Optum Care Washington PLLC CurrentSince Jan 20, 2020 Accepting new patients
Tulalip Tribes of Washington Current Accepting new patients
Optum Care Washington PLLC CurrentSince Jan 20, 2020 Accepting new patients
Multicare Health System CurrentSince Feb 5, 2017 Accepting new patients
Multicare Health System Current Accepting new patients
Tulalip Tribes of Washington CurrentSince Oct 25, 2021 Accepting new patients
Tulalip Tribes of Washington CurrentSince Oct 25, 2021 Accepting new patients

Locations

3927 Rucker Ave
Everett, WA 98201
Phone (425) 339-5419

1330 Rockefeller Ave
Everett, WA 98201
Phone (425) 258-3903

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

1201 N 175th St
Shoreline, WA 98133
Phone (425) 339-4299

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

7520 Totem Beach Rd
Tulalip, WA 98271
Phone (360) 651-4511

6406 Marine Dr
Ste A
Tulalip, WA 98271

Interoperability endpoints

  • Direct secure messaging: wkim2006111@wm.providencedirect.org

Organizations & group practices 8

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": "1188172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1962695528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7520 TOTEM BEACH RD",
            "city": "TULALIP",
            "state": "WA",
            "postal_code": "982716160",
            "telephone_number": "607-164-5113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3927 RUCKER AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014833",
            "telephone_number": "425-339-5422",
            "fax_number": "425-339-5444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7520 Totem Beach Rd",
            "address_purpose": "LOCATION",
            "city": "Tulalip",
            "state": "WA",
            "postal_code": "982716160",
            "country_code": "US",
            "telephone_number": "607-164-5113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "WOO",
        "middle_name": "CHUL",
        "name_prefix": "Dr.",
        "credential": "ARNP, DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-27",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00034802",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60673254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.