NPIMap

Individual provider Active NPI

Choll Wan Kim, M.D., PH.D

  • Orthopaedic Surgery of the Spine Physician
  • San Diego, CA
National Provider Identifier
1124043765
Registry record updated Dec 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
A64323 Issued in CA
Practice address
6719 Alvarado Rd Ste 304
San Diego, CA 92120-5265
Phone
(619) 344-6918
Fax
(619) 333-6029
NPI assigned
Jul 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X A64323 CA
Orthopaedic Surgery of the Spine Physician 207XS0117X A64323 CA Primary

Addresses

Primary practice location

6719 Alvarado Rd Ste 304
San Diego, CA 92120-5265

Mailing address

6719 Alvarado Rd Ste 304
San Diego, CA 92120-5265
Phone (619) 344-6918

Other identifiers 1

IdentifierTypeStateIssuer
00A643230MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address chollkim@excelspine.com Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective May 1, 2023 through May 1, 2027

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A64323CAMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Torrey Pines Physician Assistant Surgical Services, Inc Current Accepting new patients
Scripps Health Current Accepting new patients
Sharp Memorial Hospital Past Accepting new patients
Scripps Health Past Accepting new patients
Regents of the University of California Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: ckim42143@scrippshlth.medalliesdirect.net
  • Direct secure messaging: choll.kim@995775864635396.direct.elationemr.com

Organizations & group practices 5

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": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670803200000",
    "number": "1124043765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6719 ALVARADO RD STE 304",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921205265",
            "telephone_number": "619-344-6918",
            "fax_number": "619-333-6029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6719 ALVARADO RD STE 304",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921205265",
            "telephone_number": "619-344-6918",
            "fax_number": "619-333-6029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHOLL",
        "middle_name": "WAN",
        "name_prefix": "Dr.",
        "credential": "M.D., PH.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A64323",
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "CA",
            "license": "A64323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A643230",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "chollkim@excelspine.com",
            "affiliation": "N",
            "endpointDescription": "HIPAA compliant email",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Microsoft",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "6719 Alvarado Rd Ste 304",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921205265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.