NPIMap

Individual provider Active NPI

Jae K Kim, M.D.

  • Internal Medicine Physician
  • Fullerton, CA
National Provider Identifier
1083642839
Registry record updated Oct 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A75520 Issued in CA
Practice address
100 E Valencia Mesa Dr Ste 311
Fullerton, CA 92835-3800
Phone
(714) 446-5590
Fax
(714) 446-5592
NPI assigned
Jun 29, 2006
Last updated
Oct 19, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A75520 CA Primary

Addresses

Primary practice location

100 E Valencia Mesa Dr Ste 311
Fullerton, CA 92835-3800

Mailing address

100 E Valencia Mesa Dr Ste 311
Fullerton, CA 92835-3800
Phone (714) 446-5590

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address transitionalmedicalclinicsjuhmg@sjhhandhmg.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050817000691 CA Practitioner - Internal Medicine 1355371550 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Temple University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

1514 Valley Vista Dr
Diamond Bar, CA 91765-3929
Phone (909) 860-1144

1950 Sunny Crest Dr
Suite 2900
Fullerton, CA 92835-3641
Phone (714) 992-5350

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
75520CAMDPharmacist
A75520CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Nov 1, 2015 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Chapman Medical Center Inc Past Accepting new patients
St Jude Hospital Inc Past Accepting new patients
Sierra View Local Health Care District Past Accepting new patients
University of California Irvine Past Accepting new patients
Anaheim Global Medical Center, Inc Past Accepting new patients
Orange County Global Medical Center, Inc Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

1514 Valley Vista Dr
Diamond Bar, CA 91765
Phone (909) 560-1144

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

100 E Valencia Mesa Dr
Ste 311
Fullerton, CA 92835
Phone (714) 446-5180

101 E Valencia Mesa Dr
Fullerton, CA 92835
Phone (714) 446-7505

433 W Bastanchury Rd
Fullerton, CA 92835
Phone (714) 446-7800

Dept LA 21190
Pasadena, CA 91185

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

Organizations & group practices 8

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

Hospital & facility affiliations 2

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": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603065600000",
    "number": "1083642839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E VALENCIA MESA DR STE 311",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353800",
            "telephone_number": "714-446-5590",
            "fax_number": "714-446-5592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E VALENCIA MESA DR STE 311",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353800",
            "telephone_number": "714-446-5590",
            "fax_number": "714-446-5592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JAE",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A75520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "transitionalmedicalclinicsjuhmg@sjhhandhmg.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "100 E Valencia Mesa Dr Ste 311",
            "city": "Fullerton",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928353800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.