Samuel Kim

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

57965 Issued in CA

Practice address

2 Embarcadero Ctr Lbby Level
San Francisco, CA 94111-3823

Phone

(888) 663-6331

NPI assigned

Sep 12, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: skim366724@direct.llu.edu
• Direct secure messaging: skim706161@hisp.ehr.sutterhealth.org

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.

• Rancho Family Medical Group, Inc.

  • Family Medicine Physician
  • Temecula, CA
  • NPI 1598791600
  Medicare reassignment
• Quadmed Medical Clinics of California, Inc.

  • Primary Care Clinic/Center
  • San Bernardino, CA
  • NPI 1487151098
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1205319522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EMBARCADERO CTR STE 1900",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941113723",
            "telephone_number": "415-658-6791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 EMBARCADERO CTR LBBY LEVEL",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941113823",
            "telephone_number": "888-663-6331"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "825 E Central Ave",
            "address_purpose": "LOCATION",
            "city": "San Bernardino",
            "state": "CA",
            "postal_code": "924082413",
            "country_code": "US",
            "telephone_number": "882-616-2108",
            "fax_number": "414-622-3819",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5601 Loch Raven Blvd",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212392945",
            "country_code": "US",
            "telephone_number": "443-444-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "SAMUEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-12",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "57965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renaid Bell Kim, MD, PHD
• Riena Kim, LAC
• Robert Kim, MD
• Roy Kim, M.D.
• Sae Won Kim, DDS
• Samuel Heeju Kim
• Samuel Lee Kim
• Sarah Kim, M.D.
• Seo Ho Kim
• Seong Kim

• Physician Assistant in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.