Physician Compare National (NPI:1023095643)

HEALTHCARE PROVIDER: SOON JA KIM MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1023095643
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8224164462
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100327000006
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KIM
	Individual professional last name
Provider First Name	SOON
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WOMAN'S MEDICAL COLLEGE
	Individual professional's medical school
Graduation Year	1975
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	5808 MAIN ST
	Group Practice or individual's line 1 address
City	ELKRIDGE
	Group Practice or individual's city
State	MD
	Group Practice or individual's state
Zip Code	210755105
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	210011
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SAINT AGNES HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y