Active NPI
Chung Ja Kim
- Durable Medical Equipment & Medical Supplies
- Los Angeles, CA
National Provider Identifier
1023032406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- Practice address
- 333 S Western Ave
Ste a
Los Angeles, CA 90020-3804 - Phone
- (213) 385-9133
- Fax
- (213) 385-3121
- NPI assigned
- Jul 27, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | Primary |
Addresses
Primary practice location
333 S Western Ave
Ste a
Los Angeles, CA 90020-3804
Mailing address
333 S Western Ave
Ste a
Los Angeles, CA 90020-3804
Phone (213) 385-9133
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DME01438F | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930008589 | CA | DME Supplier - Medical Supply Company With Orthotic Personnel | 3173634110 | Practice locations: Los Angeles, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213315200000",
"number": "1023032406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 S WESTERN AVE",
"address_2": "STE A",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900203804",
"telephone_number": "213-385-9133",
"fax_number": "213-385-3121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 S WESTERN AVE",
"address_2": "STE A",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900203804",
"telephone_number": "213-385-9133",
"fax_number": "213-385-3121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "CHUNG",
"middle_name": "JA",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-27",
"last_updated": "2008-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "DME01438F",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2008; 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.