Individual provider Active NPI

Edward J. Kim, P.A.

  • Physician Assistant
  • La Jolla, CA
National Provider Identifier
1063870723
Registry record updated Feb 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
52796 Issued in CA
Practice address
9888 Genesee Ave
Trauma Service #Lj601
La Jolla, CA 92037
Phone
(858) 626-6362
NPI assigned
Feb 9, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 52796 CA Primary

Addresses

Primary practice location

9888 Genesee Ave
Trauma Service #Lj601
La Jolla, CA 92037

Mailing address

9888 Genesee Ave
Trauma Service #Lj601
La Jolla, CA 92037
Phone (858) 626-6362

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160930001805 CA Practitioner - Physician Assistant 6002103215 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Scripps HealthGroup PAC ID 9234033853, 1,450 clinicians

Practice addresses (Care Compare)

9888 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 626-4123

9896 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 626-4123

9898 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 455-9100

Hospital & facility affiliations

  • Scripps Memorial Hospital la Jolla Hospital, La Jolla, CA, CCN 050324

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
52796CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health Physician Assistant CurrentSince Sep 6, 2016 Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health CurrentSince Sep 6, 2016 Accepting new patients
Scripps Health Current Accepting new patients

Locations

9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123

9888 Genesee Ave
#601
La Jolla, CA 92037
Phone (858) 626-6350

File 54433
Los Angeles, CA 90074
Phone (858) 784-5645

10790 Rancho Bernardo Rd
#4S205
San Diego, CA 92127
Phone (858) 605-7171

Interoperability endpoints

  • Direct secure messaging: ekim13258@scrippshlth.medalliesdirect.net

Organizations & group practices 7

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1454976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454976000000",
    "number": "1063870723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9888 GENESEE AVE",
            "address_2": "TRAUMA SERVICE #LJ601",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "92037",
            "telephone_number": "858-626-6362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9888 GENESEE AVE",
            "address_2": "TRAUMA SERVICE #LJ601",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "92037",
            "telephone_number": "858-626-6362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "EDWARD",
        "middle_name": "J.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-09",
        "last_updated": "2016-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "52796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Jolla, CA

Sources for this page

Verify at the official NPI Registry.