NPIMap

Individual provider Active NPI

Sun Ik Kim, MD

  • Urology Physician
  • San Bernardino, CA
National Provider Identifier
1093738932
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
A69380 Issued in CA
Practice address
489 E 21St St
San Bernardino, CA 92404-4816
Phone
(909) 882-2973
Fax
(909) 882-2681
NPI assigned
Jul 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X A69380 CA Primary

Addresses

Primary practice location

489 E 21St St
San Bernardino, CA 92404-4816

Mailing address

489 E 21St St
San Bernardino, CA 92404-4816
Phone (909) 882-2973

Other identifiers 2

IdentifierTypeStateIssuer
0A693801MedicaidCA
00A693801OtherCABLUE CROSS & BLUE SHIELD

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
I20051205000607 CA Practitioner - Urology 0547280653 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
New York Medical College, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5832 Beach Blvd
Unit 213
Buena Park, CA 90621-5501
Phone (714) 752-6835

Hospital & facility affiliations

  • Uci Health-Orange Hospital, Orange, CA, CCN 050348
  • West Anaheim Medical Center Hospital, Anaheim, CA, CCN 050426
  • Providence St. Joseph Hospital Hospital, Orange, CA, CCN 050069
  • La Palma Intercommunity Hospital Hospital, La Palma, CA, CCN 050580
  • Ahmc Anaheim Regional Medical Center Hospital, Anaheim, CA, CCN 050226

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
95
Improvement activities
40
Cost
92.99

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A69380CAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Anaheim Global Medical Center, Inc Past Accepting new patients
Dignity Health Past Accepting new patients
St. Joseph Hospital Past Accepting new patients
Anaheim Memorial Medical Center Past Accepting new patients
Community Hospital of San Bernardino Past Accepting new patients
University of California Irvine Past Accepting new patients
St Joseph Hospital of Orange Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IBHGDD/Endpoint/IBHGDD

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093738932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "489 E 21ST ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924044816",
            "telephone_number": "909-882-2973",
            "fax_number": "909-882-2681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "489 E 21ST ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924044816",
            "telephone_number": "909-882-2973",
            "fax_number": "909-882-2681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SUN",
        "middle_name": "IK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "A69380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0A693801",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "00A693801",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.