Active NPI
Jaedeok Kim, LAC, PHD.
- Acupuncturist
- Riverside, CA
National Provider Identifier
1144793134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 18321
- Practice address
- 3858 Chicago Ave
Riverside, CA 92507-5354 - Phone
- (657) 252-1560
- Fax
- (657) 234-4001
- NPI assigned
- Jan 2, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 18321 | CA | Primary |
Addresses
Primary practice location
3858 Chicago Ave
Riverside, CA 92507-5354
Mailing address
1724 W Catalpa Ave Apt 305
Anaheim, CA 92801-4054
Phone (657) 252-1560
Other practice location 1
14151 Newport Ave Ste 102
Tustin, CA 92780-5174
Phone (657) 252-1560
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Keith Norman Kausler DC Inc-a | Single Specialty | Past | Accepting new patients |
Organizations & group practices 1
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": "1546387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552521600000",
"number": "1144793134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1724 W CATALPA AVE APT 305",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928014054",
"telephone_number": "657-252-1560",
"fax_number": "657-234-4001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3858 CHICAGO AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925075354",
"telephone_number": "657-252-1560",
"fax_number": "657-234-4001"
}
],
"practiceLocations": [
{
"address_1": "14151 Newport Ave Ste 102",
"address_purpose": "LOCATION",
"city": "Tustin",
"state": "CA",
"postal_code": "927805174",
"country_code": "US",
"telephone_number": "657-252-1560",
"fax_number": "714-838-1114",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "JAEDEOK",
"name_prefix": "Dr.",
"credential": "LAC, PHD.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-01-02",
"last_updated": "2019-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Acupuncturist",
"state": "CA",
"license": "18321",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.