Active NPI
Hwimin Kim
- Physical Therapist
- Los Angeles, CA
National Provider Identifier
1245064625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 306777
- Practice address
- 11980 San Vicente Blvd Ste 100
Los Angeles, CA 90049-6602 - Phone
- (310) 479-2323
- NPI assigned
- Aug 28, 2024
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 306777 | CA | Primary |
Addresses
Primary practice location
11980 San Vicente Blvd Ste 100
Los Angeles, CA 90049-6602
Mailing address
1360 N Mariner Way
Anaheim, CA 92801-7703
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2024
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
5016 E Shomi St
Phoenix, AZ 85044-4115
PO Box
Pasadena, CA 91189
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 306777 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Origin Physical Therapy Ca Inc | Physical Therapist | Current | Accepting new patients |
Locations
7188 Avenida Encinas
Ste 110
Carlsbad, CA 92011
11980 San Vicente Blvd
Ste 100
Los Angeles, CA 90049
Phone (310) 479-2323
Organizations & group practices 1
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.
-
- Physical Therapist
- Los Angeles, CA
- NPI 1982169595
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724803200000",
"number": "1245064625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1360 N MARINER WAY",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928017703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11980 SAN VICENTE BLVD STE 100",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900496602",
"telephone_number": "310-479-2323"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "HWIMIN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-28",
"last_updated": "2024-08-28",
"certification_date": "2024-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "306777",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.