Organization Active NPI

Sam Kim Physician Services Inc

  • Pediatrics Physician
  • Encino, CA
National Provider Identifier
1104465541
Registry record updated Feb 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SAM KIM PHYSICIAN SERVICES INC
Practice address
5400 Balboa Blvd Ste 326
Encino, CA 91316-5214
Phone
(818) 789-0941
Fax
(818) 789-6726
NPI assigned
Jan 2, 2020
Last updated
Feb 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2026

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

Authorized official

Name
Samuel Sungwon Kim, M.D.NPI 1023310687
Title
Ceo
Phone
(818) 939-4511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

5400 Balboa Blvd Ste 326
Encino, CA 91316-5214

Mailing address

5400 Balboa Blvd Ste 326
Encino, CA 91316-5214
Phone (818) 939-4511

National Provider Directory

National Provider Directory

Locations

5400 Balboa Blvd
Ste 326
Encino, CA 91316
Phone (818) 789-0492

466 Foothill Blvd
#307
La Canada, CA 91011

466 Foothill Blvd
Ste 307
La Canada Flintridge, CA 91011

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1577923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770681600000",
    "number": "1104465541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 BALBOA BLVD STE 326",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913165214",
            "telephone_number": "818-939-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 BALBOA BLVD STE 326",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913165214",
            "telephone_number": "818-789-0941",
            "fax_number": "818-789-6726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM KIM PHYSICIAN SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-02",
        "last_updated": "2026-02-10",
        "certification_date": "2026-02-10",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "SUNGWON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-939-4511",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Encino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.