Active NPI
Kwan Kim, MD
- Plastic Surgery Physician
- Van Nuys, CA
National Provider Identifier
1336241702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- A40634
- Practice address
- 15211 Vanowen St Ste 206
Van Nuys, CA 91405-3620 - Phone
- (818) 616-3070
- Fax
- (818) 997-3710
- NPI assigned
- Sep 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | A40635 | CA | |
| Plastic Surgery Physician | 208200000X | A40634 | CA | Primary |
Addresses
Primary practice location
15211 Vanowen St Ste 206
Van Nuys, CA 91405-3620
Mailing address
15211 Vanowen St
#206
Van Nuys, CA 91405
Phone (818) 616-3070
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40634 | CA | MD | Licensed Psychiatric Technician |
| A40634 | CA | MD | Plastic Surgery Physician |
| A40635 | CA | MD | Plastic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699401600000",
"number": "1336241702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15211 VANOWEN ST",
"address_2": "#206",
"city": "VAN NUYS",
"state": "CA",
"postal_code": "91405",
"telephone_number": "818-616-3070",
"fax_number": "818-997-3710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15211 VANOWEN ST STE 206",
"city": "VAN NUYS",
"state": "CA",
"postal_code": "914053620",
"telephone_number": "818-616-3070",
"fax_number": "818-997-3710"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "KWAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-05",
"last_updated": "2023-11-08",
"certification_date": "2023-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "CA",
"license": "A40635",
"primary": false
},
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "CA",
"license": "A40634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Van Nuys, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.