Jerry Kim MD Inc

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

Legal business name

JERRY KIM MD INC

Practice address

350 Vinton Ave Ste 202
Pomona, CA 91767-3000

Phone

(909) 973-1148

Fax

(909) 363-4954

NPI assigned

May 18, 2022

Organization subpart

No

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

Authorized official

Name

Jerry J KimNPI 1912295510

Title

Owner

Phone

(818) 913-2393

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jerry J Kim, MD

  • Vascular Surgery Physician
  • Pomona, CA
  • NPI 1912295510
  Medicare reassignment Care Compare group NPD Authorized official
• Ahmad Syed Hussain, M.D.

  • Vascular Surgery Physician
  • Covina, CA
  • NPI 1598999823
  Medicare reassignment Care Compare group NPD
• Alexander Lam, MD

  • Vascular Surgery Physician
  • Pomona, CA
  • NPI 1205497104
  Medicare reassignment Care Compare group NPD
• Dennis Nemceff, MD

  • Surgery Physician
  • Escondido, CA
  • NPI 1427371228
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1652832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690848000000",
    "number": "1093452278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 ROADRUNNER DR",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917502350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 VINTON AVE STE 202",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673000",
            "telephone_number": "909-973-1148",
            "fax_number": "909-363-4954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY KIM MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-18",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-913-2393"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenna Jensen
• Victoria Jenine Jensen
• Lauren Eunjae Jeong
• Ricardo Jerez
• Joellesa Catherine Jerido
• Jesse Woo MD Inc
• Telicia Kay Jett, MS, LMFT
• Kelly Jiang
• Nan Jiang, P.A.
• Xiangxiang Jiang

• Vascular Surgery Physician in Pomona, CA
• Providers in Pomona, CA by specialty
• Vascular Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; 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.

Verify at the official NPI Registry.