Individual provider Active NPI

Michelle Jangmi Kim, MD

  • Cornea and External Diseases Specialist Physician
  • Durham, NC
National Provider Identifier
1144664590
Registry record updated Nov 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cornea and External Diseases Specialist PhysicianTaxonomy code 207WX0120X
License
2017-00441 Issued in NC
Practice address
2351 Erwin Rd
Durham, NC 27705-4699
Phone
(919) 684-6611
NPI assigned
Apr 28, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X A156416 CA
Ophthalmology Physician 207W00000X 2017-00441 NC
Cornea and External Diseases Specialist Physician 207WX0120X A156416 CA
Cornea and External Diseases Specialist Physician 207WX0120X 2017-00441 NC Primary

Addresses

Primary practice location

2351 Erwin Rd
Durham, NC 27705-4699

Mailing address

2351 Erwin Rd
Durham, NC 27705-4699

Other practice location 1

4733 W Sunset Blvd Fl 3
Los Angeles, CA 90027-6021
Phone (323) 783-0339

Other practice location 2

9375 San Fernando Rd
Sun Valley, CA 91352-1418
Phone (818) 768-3000

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20180910001665 CA Practitioner - Ophthalmology 0749556355 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1255 W Arrow Hwy
San Dimas, CA 91773-2340
Phone (909) 394-2526

12761 Schabarum Ave
Irwindale, CA 91706-6807
Phone (877) 608-0044

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2017-00441NCMDOphthalmology Physician
A156416CAMDCornea and External Diseases Specialist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Serra Community Medical Clinic, Inc CurrentSince Jul 17, 2018 Accepting new patients
Southern California Permanente Medical Group CurrentSince Mar 1, 2020 Accepting new patients
Southern California Permanente Medical Group CurrentSince Mar 1, 2020 Accepting new patients
Serra Community Medical Clinic Inc Ophthalmology CurrentSince Jul 17, 2018 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Serra Community Medical Clinic, Inc. CurrentSince Jul 17, 2018 Accepting new patients

Locations

1011 Baldwin Park Blvd
Baldwin Park, CA 91706
Phone (626) 851-1011

4733 W Sunset Blvd
Fl 3
Los Angeles, CA 90027
Phone (323) 783-1431

13652 Cantara St
Panorama City, CA 91402
Phone (818) 375-2417

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

1255 W Arrow Hwy
San Dimas, CA 91773
Phone (909) 394-2526

9375 San Fernando Rd
Sun Valley, CA 91352
Phone (818) 504-4700

Organizations & group practices 6

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": "1367107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1144664590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2351 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277054699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2351 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277054699",
            "telephone_number": "919-684-6611"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4733 W Sunset Blvd Fl 3",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900276021",
            "country_code": "US",
            "telephone_number": "323-783-0339",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9375 San Fernando Rd",
            "address_purpose": "LOCATION",
            "city": "Sun Valley",
            "state": "CA",
            "postal_code": "913521418",
            "country_code": "US",
            "telephone_number": "818-768-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "MICHELLE",
        "middle_name": "JANGMI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-28",
        "last_updated": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "A156416",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NC",
            "license": "2017-00441",
            "primary": false
        },
        {
            "code": "207WX0120X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Cornea and External Diseases Specialist",
            "state": "CA",
            "license": "A156416",
            "primary": false
        },
        {
            "code": "207WX0120X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Cornea and External Diseases Specialist",
            "state": "NC",
            "license": "2017-00441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1011 Baldwin Park Blvd",
            "city": "Baldwin Park",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917065806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.