Active NPI
Ilkyoon Kim, M.D.
- Cardiovascular Disease Physician
- Clearlake, CA
National Provider Identifier
1154434728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- A34081
- Practice address
- 15666 18TH Avenue
Clearlake, CA 95422 - Phone
- (707) 994-4210
- Fax
- (707) 994-0839
- NPI assigned
- Aug 16, 2006
- 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 |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | A34081 | CA | Primary |
Addresses
Primary practice location
15666 18TH Avenue
Clearlake, CA 95422
Mailing address
PO Box 5326
Clearlake, CA 95422-5326
Phone (707) 994-4210
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A34081 | Other | CA | LICENSE NUMBER |
| 00A340810 | Medicaid | CA | |
| 68-0068216 | Other | BLUE CROSS | |
| 00A340812 | Other | CA | BLUE SHIELD |
| 00A340811 | Other | CA | BLUE SHIELD |
| 00A340811 | Medicaid | CA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404086400000",
"number": "1154434728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5326",
"city": "CLEARLAKE",
"state": "CA",
"postal_code": "954225326",
"telephone_number": "707-994-4210",
"fax_number": "707-994-0839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15666 18TH AVENUE",
"city": "CLEARLAKE",
"state": "CA",
"postal_code": "95422",
"telephone_number": "707-994-4210",
"fax_number": "707-994-0839"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "ILKYOON",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-16",
"last_updated": "2014-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "CA",
"license": "A34081",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "A34081",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A340810",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "68-0068216",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "00A340812",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "00A340811",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A340811",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clearlake, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.