Daniel Kim, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA21292 Issued in CA

Practice address

1505 W. 17TH St
San Bernardino, CA 92411-2661

Phone

(909) 887-6494

Fax

(909) 887-6043

NPI assigned

Aug 19, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chaparral Medical Group, Inc.

  • Orthopaedic Surgery Physician
  • Pomona, CA
  • NPI 1477733624
  Medicare reassignment NPD
• San Bernardino Medical Orthopaedic Group, Inc.

  dba Arrowhead Orthopaedics

  • Orthopaedic Surgery Physician
  • Redlands, CA
  • NPI 1336187475
  Medicare reassignment NPD
• Island Dermatology, Inc

  • Dermatology Physician
  • Newport Beach, CA
  • NPI 1508815556
  Medicare reassignment
• Peter Helton Professional Corporation

  • Dermatology Physician
  • Newport Beach, CA
  • NPI 1023153277
  Medicare reassignment
• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762
  Medicare reassignment
• Chaparral Medical Group Inc.

  • Cardiovascular Disease Physician
  • Upland, CA
  • NPI 1639869605
  NPD
• Hai Tran, M.D., Inc.

  • Dermatology Physician
  • Victorville, CA
  • NPI 1639366966
  NPD
• Providence Medical Foundation

  • Surgery Physician
  • Eureka, CA
  • NPI 1477790517
  NPD
• San Bernardino Medical Orthopaedic Group, Inc.

  dba Arrowhead Orthopaedics

  • Orthopaedic Surgery Physician
  • Beaumont, CA
  • NPI 1235964537
  NPD
• Direct Dermatology Professionals PC

  • Dermatology Physician
  • Manteca, CA
  • NPI 1417263922
  NPD (past)

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

{
    "created_epoch": "1313712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436400000000",
    "number": "1275813370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N PEPPER AVE 205",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923241801",
            "telephone_number": "909-580-6353",
            "fax_number": "909-580-6369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 W. 17TH ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924112661",
            "telephone_number": "909-887-6494",
            "fax_number": "909-887-6043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "DANIEL",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-19",
        "last_updated": "2015-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA21292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Billy Young Kim, PA-C
• Brandon Young Joon Kim, DDS
• Brian Chong-Han Kim, D.D.S.
• Chaelin Kim, L.AC.
• Dae Yeon Kim, FNP-C
• Daniel E Kim, PA-C
• Gregory Young Kim, BA
• Han You Kim, DDS
• Heebok Kim, MD
• Hye Seung Kim

• Physician Assistant in San Bernardino, CA
• Providers in San Bernardino, 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 9, 2015; 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.