Jiyeon Kim, NURSE PRACTITIONER

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95006590 Issued in CA

Practice address

18107 Sherman Way Ste 200
Reseda, CA 91335-8802

Phone

(818) 783-1002

NPI assigned

Nov 30, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jiyeon.kim.1@31788.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pacific Advanced Kidney Solutions Inc

  • Specialist
  • Torrance, CA
  • NPI 1992160501
  Medicare reassignment NPD
• University Faculty Associates, Inc.

  • Internal Medicine Physician
  • Fresno, CA
  • NPI 1073911137
  Medicare reassignment NPD
• Central California Faculty Medical Group, Inc.

  • Emergency Medicine Physician
  • Fresno, CA
  • NPI 1457603573
  NPD
• University Faculty Associates , Inc.

  • Vascular Surgery Physician
  • Fresno, CA
  • NPI 1881092963
  NPD
• Firooz Pak MD Inc

  • Nephrology Physician
  • Los Angeles, CA
  • NPI 1346306321
  NPD (past)
• Roze Room Hospice of the Valley Inc

  dba Roze Room Hospice of the Valley

  • Community Based Hospice Care Agency
  • Reseda, CA
  • NPI 1669474987

  Sleep Medicine

  NPD (past)

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

{
    "created_epoch": "1543536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1043780216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18107 SHERMAN WAY STE 200",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913358802",
            "telephone_number": "818-783-1112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18107 SHERMAN WAY STE 200",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913358802",
            "telephone_number": "818-783-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JIYEON",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-30",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95006590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rupinder Kaur Khosa
• Sana Khouri
• Catherine Kim, SLP
• Catherine Kim, O.D.
• Claire Mikyoung Kim
• Jung Hi Kim, MD
• Myron Seymin Kim, DDS
• Kristine Lucia King, LMFT
• Heleen Andrea Klein, PHD
• Adrean Kentray Knight, FNP

• Nurse Practitioner in Reseda, CA
• Providers in Reseda, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.