SE YEON KIM DO
NPI 1710676770
Internal Medicine in Grand Blanc, MI
About Se Yeon Kim Do NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SE YEON KIM DO (NPI 1710676770) is an individual internal medicine provider in Grand Blanc, Michigan, licensed in Michigan (5151016200) and active in the NPI registry since May 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2023).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Se Yeon Kim Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Se Yeon Kim reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Salisbury, MD 21801
- Reassigned Medicare billing, Maryland enrollment
- 531 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 48439 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
GRAND BLANC, MI 48439
GRAND BLANC, MI 48439
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Se Yeon Kim's NPI number?
The NPI number for Se Yeon Kim is 1710676770. It was assigned to this individual provider in the NPPES registry on May 4, 2023.
Where is Se Yeon Kim located?
Se Yeon Kim practices at 1 Genesys Pkwy, Grand Blanc, MI 48439. The listed phone number is (810) 606-5000.
What is Se Yeon Kim's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Se Yeon Kim enrolled in Medicare?
Yes. Se Yeon Kim is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Se Yeon Kim's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Se Yeon Kim reassigns Medicare benefits to Tidalhealth Specialty Care, LLC (Salisbury, MD). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Se Yeon Kim's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Se Yeon Kim was last updated on May 16, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Se Yeon Kim, DO · NPI 1710676770
Internal Medicine physician in Grand Blanc, Michigan. Individual provider, active in the CMS NPPES registry since May 4, 2023.
## Identity
- **NPI:** 1710676770 (Entity type: Individual)
- **Enumerated:** May 4, 2023
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **State license:** 5151016200 (Michigan)
- **Sole proprietor:** No
## Practice location
- **Address:** 1 GENESYS PKWY, Grand Blanc, MI 48439-8065
- **Phone:** (810) 606-5000
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Tidalhealth Specialty Care, LLC (NPI 1619504735, Salisbury, MD), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2023
## Record status
- **NPPES last updated:** May 16, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1710676770) · Data from the CMS NPPES public registry.