Individual provider Active NPI

Dong Pil Kim, MD

  • Physical Medicine & Rehabilitation Physician
  • Vancouver, WA
National Provider Identifier
1972607240
Registry record updated Aug 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
MD00047016 Issued in WA
Practice address
700 NE 87TH Ave
Vancouver, WA 98664-1913
Phone
(360) 254-1240
Fax
(360) 397-3128
NPI assigned
Sep 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X MD00047016 WA Primary

Addresses

Primary practice location

700 NE 87TH Ave
Vancouver, WA 98664-1913

Mailing address

700 NE 87TH Ave
Vancouver, WA 98664-1913
Phone (360) 254-1240

Other identifiers 1

IdentifierTypeStateIssuer
8462590MedicaidWA

Other names 1

  • Edward Kim Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061026000448 WA Practitioner - Physical Medicine and Rehabilitation 7315944774 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Loma Linda University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Vancouver Clinic Inc PSGroup PAC ID 3173436490, 580 clinicians

Practice addresses (Care Compare)

700 NE 87TH Ave
Vancouver, WA 98664-1913
Phone (360) 882-2778

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
The Vancouver Clinic Pharmacy Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: ekim4714@tvc-direct.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597708800000",
    "number": "1972607240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 NE 87TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986641913",
            "telephone_number": "360-254-1240",
            "fax_number": "360-397-3128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 NE 87TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986641913",
            "telephone_number": "360-254-1240",
            "fax_number": "360-397-3128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "DONG",
        "middle_name": "PIL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-08",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WA",
            "license": "MD00047016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8462590",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EDWARD",
            "last_name": "KIM",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.