NPIMap

Individual provider Active NPI

Taeho Kim, PA

  • Physician Assistant
  • Walnut Creek, CA
National Provider Identifier
1245751775
Registry record updated Feb 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
54634 Issued in CA
Practice address
1808 San Miguel Dr
Walnut Creek, CA 94596-8606
Phone
(925) 528-2663
NPI assigned
Jul 6, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 54634 CA Primary

Addresses

Primary practice location

1808 San Miguel Dr
Walnut Creek, CA 94596-8606

Mailing address

1808 San Miguel Dr
Walnut Creek, CA 94596-8606

Other names 1

  • Tae Kim Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170727003523 CA Practitioner - Physician Assistant 7113297854 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stanford Health CareGroup PAC ID 6709797491, 3,152 clinicians
Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

2452 Watson CT
Palo Alto, CA 94303-3216
Phone (650) 723-6995

2800 L St
Sacramento, CA 95816-5616

300 Pasteur Dr
Stanford, CA 94305-2200
Phone (650) 723-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.39 of 100Reported as group
Quality
75.67
Promoting interoperability
100
Improvement activities
40
Cost
74.51

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
54634CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Acute Care Surgery Medical Group, Inc. Orthopaedic Surgery CurrentSince Jun 1, 2023 Accepting new patients
Advanced Sleep Diagnostics, Inc. CurrentSince May 1, 2023 Accepting new patients
Sutter Valley Medical Foundation Orthopaedic Surgery CurrentSince Sep 6, 2024 Accepting new patients
Stanford Health Care CurrentSince Jun 5, 2023 Accepting new patients
Sutter Valley Medical Foundation CurrentSince Sep 6, 2024 Accepting new patients
Stanford Health Care CurrentSince Jun 5, 2023 Accepting new patients
Bass Medical Group Orthopaedic Surgery Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients
Sutter North Medical Foundation Past Accepting new patients
Sutter Delta Medical Center Past Accepting new patients

Locations

2020 Sutter Pl
Ste 104
Davis, CA 95616
Phone (530) 750-5900

2720 Low Ct
Fairfield, CA 94534
Phone (707) 428-2731

815 Court St
Ste 7
Jackson, CA 95642
Phone (209) 257-5900

726 4th St
Marysville, CA 95901
Phone (530) 491-9491

414 G St
Ste 120
Marysville, CA 95901
Phone (530) 749-2110

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

4001 J St
Sacramento, CA 95819
Phone (916) 453-4037

300 Pasteur Dr
Stanford, CA 94305
Phone (650) 498-5710

1800 Spring Ridge Dr
Susanville, CA 96130
Phone (530) 252-2225

Interoperability endpoints

  • Direct secure messaging: taeho.kim@22525392.chartlogic.direct-ci.com
  • Direct secure messaging: tkim380979@hisp.ehr.sutterhealth.org
  • Direct secure messaging: tkim112406@ehr.johnmuirhealth.com

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1499299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739232000000",
    "number": "1245751775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1808 SAN MIGUEL DR",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945968606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 SAN MIGUEL DR",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945968606",
            "telephone_number": "925-528-2663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "TAEHO",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-06",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "54634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAE",
            "last_name": "KIM",
            "credential": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.