Individual provider Active NPI

Steven Park Kim, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Santa Rosa, CA
National Provider Identifier
1306877006
Registry record updated Apr 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
E4506 Issued in CA
Practice address
4761 Hoen Ave
Santa Rosa, CA 95405-7862
Phone
(707) 545-0570
Fax
(707) 545-0575
NPI assigned
Jul 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X E4506 CA Primary

Addresses

Primary practice location

4761 Hoen Ave
Santa Rosa, CA 95405-7862

Mailing address

3536 Mendocino Ave
200
Santa Rosa, CA 95403-3634
Phone (707) 575-6049

Other identifiers 2

IdentifierTypeStateIssuer
P01011615OtherCARAILROAD MEDICARE
000E45060MedicaidCA

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040305000498 CA Practitioner - Podiatry 8729976485 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
California School of Podiatric Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

Practice addresses (Care Compare)

3883 Airway Dr
Suite 165
Santa Rosa, CA 95403-1675
Phone (707) 521-7799

Hospital & facility affiliations

  • California Pacific Medical Ctr-Davies Campus Hosp Hospital, San Francisco, CA, CCN 050008

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions47
Removal of nail tissue102
Removal or shaving of skin growth430

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4506CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation CurrentSince Aug 1, 2017 Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation CurrentSince Aug 1, 2017 Accepting new patients
Sutter East Bay Medical Foundation Foot & Ankle Surgery Past Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients

Locations

795 El Camino Real
#1112
Palo Alto, CA 94301

131 Stony Cir
Ste 1600
Santa Rosa, CA 95401
Phone (707) 541-7700

4700 Hoen Ave
Santa Rosa, CA 95405
Phone (707) 526-3360

3883 Airway Dr
Ste 220
Santa Rosa, CA 95403
Phone (707) 521-7750

3883 Airway Dr
Ste 165
Santa Rosa, CA 95403
Phone (707) 521-7799

Interoperability endpoints

  • Direct secure messaging: skim208985@hisp.ehr.sutterhealth.org

Organizations & group practices 6

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.

Hospital & facility affiliations 1

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334707200000",
    "number": "1306877006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3536 MENDOCINO AVE",
            "address_2": "200",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033634",
            "telephone_number": "707-575-6049",
            "fax_number": "707-545-0575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4761 HOEN AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954057862",
            "telephone_number": "707-545-0570",
            "fax_number": "707-545-0575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "STEVEN",
        "middle_name": "PARK",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2012-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E4506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01011615",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000E45060",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.