Individual provider Active NPI

Myung Kim, MD

  • Anesthesiology Physician
  • Modesto, CA
National Provider Identifier
1104842640
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
G81752 Issued in CA
Practice address
1441 Florida Ave
Modesto, CA 95350-4405
Phone
(209) 578-1211
NPI assigned
Jul 15, 2006
Sex
Male
Sole proprietor
Yes

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
Anesthesiology Physician 207L00000X G81752 CA Primary

Addresses

Primary practice location

1441 Florida Ave
Modesto, CA 95350-4405

Mailing address

PO Box 28128
Fresno, CA 93729-8128
Phone (559) 436-0871

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071101000578 CA Practitioner - Anesthesiology 5193812592 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G81752CAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Regional Anesthesia Associates Inc Anesthesiology CurrentSince Dec 6, 2023 Accepting new patients
First Choice Physician Partners CurrentSince Jun 15, 2019 Accepting new patients
First Choice Physician Partners CurrentSince Jun 15, 2019 Accepting new patients
First Choice Physician Partners Past Accepting new patients

Locations

2615 Chester Ave
Bakersfield, CA 93301
Phone (661) 381-7545

3001 Sillect Ave
Bakersfield, CA 93308
Phone (661) 316-6000

2139 E Beechwood Ave
Fresno, CA 93720
Phone (559) 322-6600

1660 W 3rd St
Los Angeles, CA 90017
Phone (213) 201-0850

145 Trevino Ave
Manteca, CA 95337
Phone (209) 788-8180

1205 E North St
Manteca, CA 95336
Phone (209) 239-8301

1421 Oakdale Rd
Modesto, CA 95355
Phone (209) 572-0151

1441 Florida Ave
Modesto, CA 95350
Phone (209) 214-7235

1541 Florida Ave
Ste 101
Modesto, CA 95350
Phone (209) 575-3839

1300 Mable Ave
Ste 1
Modesto, CA 95355
Phone (209) 571-1633

465 W Putnam Ave
Porterville, CA 93257
Phone (559) 784-8886

2900 Eureka Way
Redding, CA 96001
Phone (530) 225-8700

825 Delbon Ave
Turlock, CA 95382
Phone (209) 664-2744

119 S Locust St
#B
Visalia, CA 93291
Phone (559) 366-7177

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104842640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 28128",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937298128",
            "telephone_number": "559-436-0871",
            "fax_number": "559-436-5221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 FLORIDA AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504405",
            "telephone_number": "209-578-1211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MYUNG",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G81752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.