Dong S. Kim, M.D., Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A48273 Issued in CA

Legal business name

DONG S. KIM, M.D., INC

Practice address

11441 Heacock St
Ste. F
Moreno Valley, CA 92557-7907

Phone

(951) 243-8000

Fax

(951) 243-9707

NPI assigned

Aug 30, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Dong Soo Kim, M.D.NPI 1942267992

Title

Owner

Phone

(951) 243-8000

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dong S Kim, M.D.

  • Specialist
  • Moreno Valley, CA
  • NPI 1942267992
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435276800000",
    "number": "1013027465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11441 HEACOCK ST",
            "address_2": "STE. F",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925577907",
            "telephone_number": "951-243-8000",
            "fax_number": "951-243-9707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11441 HEACOCK ST",
            "address_2": "STE. F",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925577907",
            "telephone_number": "951-243-8000",
            "fax_number": "951-243-9707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DONG S. KIM, M.D., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2015-06-26",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "DONG",
        "authorized_official_middle_name": "SOO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-243-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A48273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013027465",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENCE",
            "identifier": "A48273",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roberto Dominicci Rodriguez, PPS
• Don Schubothe Dental, Inc.
• Donald L Iman DDS Inc.
• William Donald, RN, EMT-P, ATC
• Livia Anastasia Donets, PA-C
• David K Dong, M.D.
• Misook Doo, ACUPUNCTURIST
• Christina Dorame, LVN
• Alexandr V Doroshenko, DDS
• William Kent Dorrance, OD

• Internal Medicine Physician in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.