Active NPI
Kyungyeon Kim, RD
- Registered Dietitian
- Pomona, CA
National Provider Identifier
1194339143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86072483
- Practice address
- 1770 Rockview Way
Pomona, CA 91766-5285 - Phone
- (917) 575-8045
- NPI assigned
- Sep 6, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | |||
| Registered Dietitian | 133V00000X | 86072483 | Primary |
Addresses
Primary practice location
1770 Rockview Way
Pomona, CA 91766-5285
Mailing address
1770 Rockview Way
Pomona, CA 91766-5285
Phone (917) 575-8045
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": "1599350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599350400000",
"number": "1194339143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1770 ROCKVIEW WAY",
"city": "POMONA",
"state": "CA",
"postal_code": "917665285",
"telephone_number": "917-575-8045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1770 ROCKVIEW WAY",
"city": "POMONA",
"state": "CA",
"postal_code": "917665285",
"telephone_number": "917-575-8045"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "KYUNGYEON",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-06",
"last_updated": "2020-09-06",
"certification_date": "2020-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dietitian, Registered",
"state": null,
"license": "86072483",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pomona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.