NPIMap

Organization Active NPI

Jiensup Kim MD a Professional Corporation

Doing business as Mission Medical

  • Specialist
  • Colton, CA
National Provider Identifier
1306183835
Registry record updated Feb 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
G75806 Issued in CA
Legal business name
JIENSUP KIM MD A PROFESSIONAL CORPORATION
Doing business as
Mission Medical
Practice address
900 E Washington St
Suite 100a
Colton, CA 92324-4120
Phone
(909) 370-0300
Fax
(909) 370-0303
NPI assigned
Jan 3, 2013
Last updated
Feb 20, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2013

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

Authorized official

Name
Dr. Jiensup Kim, MDNPI 1639131154
Title
President
Phone
(909) 370-0300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X G75806 CA Primary

Addresses

Primary practice location

900 E Washington St
Suite 100a
Colton, CA 92324-4120

Mailing address

900 E Washington St
Suite 100a
Colton, CA 92324-4120
Phone (909) 370-0300

Other names 1

  • Mission Medical Doing business as

National Provider Directory

National Provider Directory

Locations

900 E Washington St
Ste 301
Colton, CA 92324
Phone (909) 370-0300

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1357171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361318400000",
    "number": "1306183835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 E WASHINGTON ST",
            "address_2": "SUITE 100A",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923244120",
            "telephone_number": "909-370-0300",
            "fax_number": "909-370-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 E WASHINGTON ST",
            "address_2": "SUITE 100A",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923244120",
            "telephone_number": "909-370-0300",
            "fax_number": "909-370-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIENSUP KIM MD A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-03",
        "last_updated": "2013-02-20",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JIENSUP",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-370-0300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G75806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mission Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.