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

Jisoo Kim

Individual provider Surgery Physician · NPI 1154819878

Jisoo Kim is a General Surgery in Greenville, North Carolina. Qualified in 2018, 8 years ago. Practices with Vidant Medical Group LLC, a 974-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
8
Licensed in
NC
In the registry since
2018

Practice location Address checks out

517 Moye Blvd
Greenville, NC 27834-2849
Phone: (252) 744-2393
Fax: (252) 744-0013
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgery Physician (primary) Taxonomy 208600000X · Licence 2022-02860 (NC)

Record details

NPI number1154819878
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 27, 2018
Last updated in NPPESSeptember 24, 2024
Certification dateSeptember 24, 2024

Medicare enrollment

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

Medicare specialtyGENERAL SURGERY
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Vidant Medical Group Llc — 974 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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