Angie Byung Ju Kim, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

55199 Issued in CA

Practice address

1855 N Fair Oaks Ave
Pasadena, CA 91103-1620

Phone

(626) 993-1221

NPI assigned

Dec 4, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Providence Facey Medical Foundation

  • Internal Medicine Physician
  • Valencia, CA
  • NPI 1710031588
  Medicare reassignment NPD
• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762
  Medicare reassignment NPD
• Anaheim Emergency Medical Group

  • Emergency Medicine Physician
  • Anaheim, CA
  • NPI 1114626017
  Medicare reassignment
• Intercommunity Emergency Medical Group

  • Emergency Medicine Physician
  • Whittier, CA
  • NPI 1871535286
  Medicare reassignment
• Providence Facey Medical Foundation

  • Multi-Specialty Clinic/Center
  • Irvine, CA
  • NPI 1891348447
  NPD

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

{
    "created_epoch": "1512345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618963200000",
    "number": "1144735895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 W MONTANA ST",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911031327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 N FAIR OAKS AVE",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911031620",
            "telephone_number": "626-993-1221"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2501 E Chapman Ave",
            "address_purpose": "LOCATION",
            "city": "Orange",
            "state": "CA",
            "postal_code": "928693204",
            "country_code": "US",
            "telephone_number": "714-633-1011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2251 N Harbor Blvd",
            "address_purpose": "LOCATION",
            "city": "Fullerton",
            "state": "CA",
            "postal_code": "928352601",
            "country_code": "US",
            "telephone_number": "714-449-6230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2212 E 4th St Ste 103",
            "address_purpose": "LOCATION",
            "city": "Santa Ana",
            "state": "CA",
            "postal_code": "927053871",
            "country_code": "US",
            "telephone_number": "714-571-7700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "26800 Crown Valley Pkwy Ste 150",
            "address_purpose": "LOCATION",
            "city": "Mission Viejo",
            "state": "CA",
            "postal_code": "926918018",
            "country_code": "US",
            "telephone_number": "949-276-2111",
            "fax_number": "949-276-2116",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "ANGIE",
        "middle_name": "BYUNG JU",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-04",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "55199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "urgentcaresjohmg@sjhhandhmg.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "5630 E Santa Ana Canyon Rd Ste 100",
            "city": "Anaheim",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928073122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Adina Kim, MSW
• Alice S Kim, MD
• Amy Lynn Kim, MD
• Andrew Dong-Wook Kim
• Angela Sunmin Kim, FNP
• Ashlee Kim, MFT
• Bo K Kim, MD
• Carolyn Krystal Kim, MD
• Christina Kim
• Cindy Kim, LCSW

• Physician Assistant in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.