Active NPI
Kwan Soo Kim, M.D.
- General Practice Physician
- Loma Linda, CA
National Provider Identifier
1174803530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- CFE52187
- Practice address
- 24261 Paulson Dr.
Loma Linda, CA 92354-4873 - Phone
- (909) 796-5251
- NPI assigned
- Aug 17, 2011
- 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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | CFE52187 | CA | Primary |
Addresses
Primary practice location
24261 Paulson Dr.
Loma Linda, CA 92354-4873
Mailing address
24261 Paulson Dr.
Loma Linda, CA 92354
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1082379 | Medicaid | MI |
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CFE52187 | CA | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313539200000",
"number": "1174803530",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24261 PAULSON DR.",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "92354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24261 PAULSON DR.",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923544873",
"telephone_number": "909-796-5251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "KWAN",
"middle_name": "SOO",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-17",
"last_updated": "2011-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "CA",
"license": "CFE52187",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1082379",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.