Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dae Woong Kim

Individual provider Physician Assistant · NPI 1386132652

Dae Woong Kim is a Physician Assistant in Queen Creek, Arizona. Qualified in 2018, 8 years ago. Practices with Prescott Healthcare Solutions LLC, a 199-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Arizona.

Years since qualifying
8
Licensed in
AZ
In the registry since
2018
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Practice location Address checks out

21321 E Ocotillo Rd Ste 133
Queen Creek, AZ 85142-5995
Phone: (480) 987-5525
Fax: (480) 987-5115
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 7074 (AZ)

Record details

NPI number1386132652
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 23, 2018
Last updated in NPPESJanuary 6, 2023
Certification dateJanuary 6, 2023
Mailing address21321 E Ocotillo Rd Ste 133, Queen Creek, AZ 85142-5995

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Prescott Healthcare Solutions Llc — 199 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

Other providers in Queen Creek