MINJI KIM (NPI# 1720424591) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720424591 |
| Entity Type | Individual |
| Full Name | MINJI KIM |
| Credential | M.D. |
| Practice Address |
920 Royal Ave Medford OR 97504-6169 |
| Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
| Practice Telephone | 5417328400 |
| Practice Fax Number | 5417323407 |
| Mailing Telephone | 5417328400 |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2020-01-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
MD196401 | OR | Allopathic & Osteopathic Physicians |
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
MD60861213 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | MEDICARE | R213587 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043824485 | Minji Kim | Student in an Organized Health Care Education/Training Program | 9808 Venice Blvd Ste 700, Culver City, CA 90232-6824 | 2020-09-02 |
| 1861991119 | Minji Kim | Community Health Worker | 3051 Main Street, Anaktuvuk Pass, AK 99721 | 2018-02-01 |
| 1558889311 | Minji Kim | Behavior Technician | 15600 Redmond Way Ste 205, Redmond, WA 98052-3862 | 2017-08-31 |
| 1134507411 | Minji Kim | Behavioral Analyst | 13405 Saddle Back Pass, Austin, TX 78738-6147 | 2015-05-07 |
| Street Address |
920 ROYAL AVE |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504-6169 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114927753 | Michael Steven Narus | Psychiatry & Neurology | 920 Royal Ave, Medford, OR 97504-6169 | 2005-07-26 |
| 1881006997 | Erin Marie Dittmer | Nurse Practitioner | 920 Royal Ave, Medford, OR 97504-6169 | 2014-05-22 |
| 1790038495 | Jennifer Katharine Boudreaux | Nurse Practitioner | 920 Royal Ave, Medford, OR 97504-6169 | 2012-10-18 |
| 1578821013 | Sabre Amira Patton-fee | Psychiatry & Neurology | 920 Royal Ave, Medford, OR 97504 | 2012-05-02 |
| 1689955536 | Pawani Sachar | Psychiatry & Neurology | 920 Royal Ave, Medford, OR 97504-6169 | 2011-09-06 |
| 1275821746 | Oregon Ear Nose and Throat Surgery | Clinic/Center | 920 Royal Ave, Medford, OR 97504-6169 | 2011-07-18 |
| 1063705887 | Providence Health & Services - Oregon | Clinic/Center | 920 Royal Ave, Medford, OR 97504-6169 | 2011-05-26 |
| 1639279243 | Donald M Olson | Psychiatry & Neurology | 920 Royal Ave, Medford, OR 97504-6169 | 2006-09-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659519767 | Cynthia Shearn Tainsh | Psychiatry & Neurology | 97 Westwood Rd, Medford, MA 02155-1637 | 2009-01-27 |
| 1528217460 | Christopher Dardis | Psychiatry & Neurology | 2900 State St Ste 101, Medford, OR 97504-8458 | 2008-09-16 |
| 1225249675 | Bruce Ehrenberg | Psychiatry & Neurology | 4 Colby St, Medford, MA 02155-6013 | 2007-05-25 |
| 1366658627 | Nishant Singh Ranawat | Psychiatry & Neurology | Asante Rogue Regional Medical Center, 2825 E Barnett Road, Medford, OR 97504 | 2007-05-15 |
| 1922143296 | Eugenia Blank | Psychiatry & Neurology | 170 Governors Ave Ste 258, Medford, MA 02155-1643 | 2007-02-21 |
| 1912963661 | Larry Jou Maukonen | Psychiatry & Neurology | 897 Royal Ave, Suite B, Medford, OR 97504 | 2006-04-21 |
| 1265416317 | South Jersey Neurocare Pa | Psychiatry & Neurology | 520 Stokes Rd, Suite A-4, Medford, NJ 08055-2904 | 2005-12-02 |
| 1063412427 | Oscar Adolfo Sanchez | Psychiatry & Neurology | 520 Medical Center Drive, Medford, OR 97504 | 2005-07-28 |
| 1578821013 | Sabre Amira Patton-fee | Psychiatry & Neurology | 920 Royal Ave, Medford, OR 97504 | 2012-05-02 |
| 1689955536 | Pawani Sachar | Psychiatry & Neurology | 920 Royal Ave, Medford, OR 97504-6169 | 2011-09-06 |
| Find all providers in MEDFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.