Active NPI
Kim Bonaccorso
- Counselor
- Santa Ana, CA
National Provider Identifier
1093174336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 2100 N Broadway
101
Santa Ana, CA 92706-2624 - Phone
- (714) 245-6881
- NPI assigned
- Feb 15, 2016
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
2100 N Broadway
101
Santa Ana, CA 92706-2624
Mailing address
2100 N Broadway
101
Santa Ana, CA 92706-2624
Phone (714) 245-6881
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A9578135 | Other | CA | DRIVER LICENSE NUMBER |
Other names 1
- Ms. Kim Bonaccorso Shipman
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
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": "1455494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455494400000",
"number": "1093174336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 N BROADWAY",
"address_2": "101",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "927062624",
"telephone_number": "714-245-6881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 N BROADWAY",
"address_2": "101",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "927062624",
"telephone_number": "714-245-6881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONACCORSO",
"first_name": "KIM",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-02-15",
"last_updated": "2016-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVER LICENSE NUMBER",
"identifier": "A9578135",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KIM",
"last_name": "SHIPMAN",
"middle_name": "BONACCORSO",
"prefix": "MS.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Santa Ana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.