Active NPI
Changho Kim
- Student in an Organized Health Care Education/Training Program
- Glendale, CA
National Provider Identifier
1174306872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 333 W Loraine St Apt 106
Glendale, CA 91202-4423 - Phone
- (661) 565-5932
- NPI assigned
- Aug 16, 2023
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
333 W Loraine St Apt 106
Glendale, CA 91202-4423
Mailing address
333 W Loraine St Apt 106
Glendale, CA 91202-4423
Phone (661) 565-5932
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692144000000",
"number": "1174306872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 W LORAINE ST APT 106",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912024423",
"telephone_number": "661-565-5932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 W LORAINE ST APT 106",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912024423",
"telephone_number": "661-565-5932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "CHANGHO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-08-16",
"last_updated": "2023-08-16",
"certification_date": "2023-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.