Active NPI
So Hyeoung Kim
- Primary Care Nurse Practitioner
- South Pasadena, CA
National Provider Identifier
1346111879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Nurse Practitioner
- License
- NP95035312
- Practice address
- 1650 Amberwood Dr Apt C
South Pasadena, CA 91030-1926 - Phone
- (626) 476-1139
- NPI assigned
- Sep 17, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | NP95035312 | CA | Primary |
Addresses
Primary practice location
1650 Amberwood Dr Apt C
South Pasadena, CA 91030-1926
Mailing address
1650 Amberwood Dr Apt C
South Pasadena, CA 91030-1926
Phone (626) 476-1139
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP95035312 | CA | MD | Primary Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1758067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758067200000",
"number": "1346111879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1650 AMBERWOOD DR APT C",
"city": "SOUTH PASADENA",
"state": "CA",
"postal_code": "910301926",
"telephone_number": "626-476-1139"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1650 AMBERWOOD DR APT C",
"city": "SOUTH PASADENA",
"state": "CA",
"postal_code": "910301926",
"telephone_number": "626-476-1139"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SO HYEOUNG",
"name_prefix": "Miss",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-09-17",
"last_updated": "2025-09-17",
"certification_date": "2025-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "363LP2300X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Primary Care",
"state": "CA",
"license": "NP95035312",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2025; 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.