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

Dr. Shane Christopher Kim, MD

Individual provider Plastic Surgery Physician · NPI 1871623678

Dr. Shane Christopher Kim, MD is a Plastic and Reconstructive Surgery in Portland, Oregon. Qualified in 2002, 24 years ago. Practices with Legacy Clinics LLC, a 718-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Oregon.

Years since qualifying
24
Licensed in
OR
In the registry since
2007
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1130 NW 22nd Ave Ste 420
Portland, OR 97210-2995
Phone: (503) 413-4992
Fax: (503) 413-3699
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Plastic Surgery Physician (primary) Taxonomy 208200000X · Licence MD29423 (OR)

Record details

NPI number1871623678
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedMarch 7, 2007
Last updated in NPPESJuly 15, 2013
Mailing address1130 Nw 22nd Ave Ste 420, Portland, OR 97210-2995

Medicare enrollment

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

Medicare specialtyPLASTIC AND RECONSTRUCTIVE SURGERY
Also practisesHAND SURGERY
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Group practice Legacy Clinics Llc — 718 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations6 on file with Medicare

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