Active NPI
Jaesung Kim, M.D.
- Neurology Physician
- Vancouver, WA
National Provider Identifier
1962834796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- MD61054444
- Practice address
- 2211 NE 139TH St
Vancouver, WA 98686 - Phone
- (360) 487-1000
- NPI assigned
- Aug 2, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 33238 | OK | |
| Neurology Physician | 2084N0400X | MD61054444 | WA | Primary |
| Neurology Physician | 2084N0400X | MD226000 | OR |
Addresses
Primary practice location
2211 NE 139TH St
Vancouver, WA 98686
Mailing address
PO Box 2777
Portland, OR 97208-2777
Other practice location 1
505 NE 87th Ave Ste 460
Vancouver, WA 98664-1965
Phone (360) 514-7771
Other practice location 2
2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200
Other practice location 3
1120 S Utica Ave
Tulsa, OK 74104-4012
Phone (918) 579-1000
Other practice location 4
2451 Fillingim St
Res Box 7th Floor
Mobile, AL 36617-2238
Phone (251) 471-7207
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA, OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Neurology
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
2211 NE 139TH St
Vancouver, WA 98686-2742
Phone 3604871000360487
2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-2200
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33238 | OK | MD | Neurology Physician |
| MD61054444 | WA | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Legacy Salmon Creek Hospital | Current | Accepting new patients | |
| Silverton Health | Current | Accepting new patients | |
| Legacy Clinics LLC | Current | Accepting new patients | |
| Legacy Salmon Creek Hospital | Current | Accepting new patients | |
| Silverton Health | Current | Accepting new patients | |
| Silverton Health | Current | Accepting new patients |
Locations
2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200
1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600
1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134
347 Fairview St
Silverton, OR 97381
Phone (503) 873-5667
342 Fairview St
Silverton, OR 97381
Phone (503) 525-7660
2211 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1985
Interoperability endpoints
- jkim451549@direct.peacehealth.org
Organizations & group practices 6
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.
-
- Clinic/Center
- Vancouver, WA
- NPI 1356357784
-
- Clinic/Center
- Portland, OR
- NPI 1902827272
-
- General Acute Care Hospital
- Silverton, OR
- NPI 1669424354
-
- General Acute Care Hospital
- Vancouver, WA
- NPI 1700809829
-
- Clinic/Center
- Molalla, OR
- NPI 1861116055
-
- Clinic/Center
- Silverton, OR
- NPI 1871214304
Hospital & facility affiliations 9
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Vancouver, WA
- NPI 1700809829
-
- General Acute Care Hospital
- Vancouver, WA
- NPI 1134178999
-
- General Acute Care Hospital
- Portland, OR
- NPI 1003367491
-
- Clinical Medical Laboratory
- Portland, OR
- NPI 1295756898
Hospital
-
- General Acute Care Hospital
- Portland, OR
- NPI 1831112358
-
- General Acute Care Hospital
- Gresham, OR
- NPI 1255354700
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753228800000",
"number": "1962834796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2777",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972082777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2211 NE 139TH ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "98686",
"telephone_number": "360-487-1000"
}
],
"practiceLocations": [
{
"address_1": "505 NE 87th Ave Ste 460",
"address_purpose": "LOCATION",
"city": "Vancouver",
"state": "WA",
"postal_code": "986641965",
"country_code": "US",
"telephone_number": "360-514-7771",
"fax_number": "360-514-7769",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2801 N Gantenbein Ave",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "97227",
"country_code": "US",
"telephone_number": "503-413-2200",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1120 S Utica Ave",
"address_purpose": "LOCATION",
"city": "Tulsa",
"state": "OK",
"postal_code": "741044012",
"country_code": "US",
"telephone_number": "918-579-1000",
"fax_number": "918-560-5761",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2451 Fillingim St",
"address_2": "Res Box 7th Floor",
"address_purpose": "LOCATION",
"city": "Mobile",
"state": "AL",
"postal_code": "366172238",
"country_code": "US",
"telephone_number": "251-471-7207",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "JAESUNG",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-02",
"last_updated": "2025-07-23",
"certification_date": "2025-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "OK",
"license": "33238",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "WA",
"license": "MD61054444",
"primary": true
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "OR",
"license": "MD226000",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.