Active NPI
Sang Cheul Kim, MD
- Obstetrics & Gynecology Physician
- Anaheim, CA
National Provider Identifier
1205885217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- C41227
- Practice address
- 3340 West Ball Rd
#D
Anaheim, CA 92804 - Phone
- (714) 827-0390
- Fax
- (714) 827-5375
- NPI assigned
- May 8, 2006
- Last updated
- Aug 3, 2010
- 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 |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | C41227 | CA | Primary |
Addresses
Primary practice location
3340 West Ball Rd
#D
Anaheim, CA 92804
Mailing address
3340 West Ball Rd
#D
Anaheim, CA 92804
Phone (714) 827-0390
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00C412271 | Medicaid | CA |
Medicare participation
Medicare enrollment files- 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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101005000742 | CA | Practitioner - Obstetrics/Gynecology | 9436341732 | Practice locations: Ahaheim, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41227 | CA | MD | General Practice Dentistry |
| C41227 | CA | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280793600000",
"number": "1205885217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3340 WEST BALL RD",
"address_2": "#D",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "92804",
"telephone_number": "714-827-0390",
"fax_number": "714-827-5375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3340 WEST BALL RD",
"address_2": "#D",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "92804",
"telephone_number": "714-827-0390",
"fax_number": "714-827-5375"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SANG",
"middle_name": "CHEUL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-08",
"last_updated": "2010-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "CA",
"license": "C41227",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00C412271",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2010; 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.