Wanseung Kim, APRN
Nurse Practitioner, Family in Las Vegas, NV. Individual provider (NPI-1).
NPI number1104547769
StatusActive
Last updated in NPPESAug 4, 2026
Details
- NPI
- 1104547769
- Entity type
- Individual (NPI-1)
- Name
- Wanseung Kim
- Credential
- APRN
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 12, 2022
- Certification date
- Aug 4, 2026
- Last updated
- Aug 4, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - NURSE PRACTITIONER
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 856178 | NV | Yes |
| 163W00000X | Registered Nurse | RN67339 | NV |
Other names
- Vincent Wanseung Kim (Other Name)
Practice location
3150 N Tenaya Way Ste 525Las Vegas, NV 89128-0465
Phone 725-204-6520
Mailing address
5367 Peacock Lily StLas Vegas, NV 89113-1267
Phone 702-218-0133
Other practice locations
2235 E Flamingo Rd Ste 208
Las Vegas, NV 89119-5152
Las Vegas, NV 89119-5152
Phone 702-760-0341
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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