Active NPI
Jenny Kim, PA-C
- Physician Assistant
- Torrance, CA
National Provider Identifier
1205560869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA64653
- Practice address
- 21250 Hawthorne Blvd Ste 430
Torrance, CA 90503-5511 - Phone
- (310) 326-3063
- Fax
- (310) 326-3068
- NPI assigned
- Jul 11, 2022
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA64653 | CA | Primary |
Addresses
Primary practice location
21250 Hawthorne Blvd Ste 430
Torrance, CA 90503-5511
Mailing address
21250 Hawthorne Blvd Ste 430
Torrance, CA 90503-5511
Phone (310) 326-3063
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA64653 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1657497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728000000000",
"number": "1205560869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21250 HAWTHORNE BLVD STE 430",
"city": "TORRANCE",
"state": "CA",
"postal_code": "905035511",
"telephone_number": "310-326-3063"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21250 HAWTHORNE BLVD STE 430",
"city": "TORRANCE",
"state": "CA",
"postal_code": "905035511",
"telephone_number": "310-326-3063",
"fax_number": "310-326-3068"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JENNY",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-11",
"last_updated": "2024-10-04",
"certification_date": "2024-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA64653",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Torrance, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 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.