Individual provider Active NPI

Eunice R Kim, M.D.

  • Pediatrics Physician
  • Sacramento, CA
National Provider Identifier
1356662928
Registry record updated Mar 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A118412 Issued in CA
Practice address
2315 Stockton Blvd
Sacramento, CA 95817-2201
Phone
(916) 734-0308
NPI assigned
Jun 18, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A118412 CA Primary

Addresses

Primary practice location

2315 Stockton Blvd
Sacramento, CA 95817-2201

Mailing address

2315 Stockton Blvd
Sacramento, CA 95817-2201

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130726000748 CA Practitioner - Pediatric Medicine 8628219003 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the Univ of Ca Current Accepting new patients
Regents of the University of Ca Pediatrics CurrentSince Jul 1, 2013 Accepting new patients
Regents of the Univ of Ca CurrentSince Jul 1, 2013 Accepting new patients

Locations

2315 Stockton Blvd
Sacramento, CA 95817
Phone (916) 703-3030

4900 Broadway
Ste 2800
Sacramento, CA 95820
Phone (916) 734-9313

2521 Stockton Blvd
Ste 3200
Sacramento, CA 95817
Phone (916) 734-3112

2521 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-1104

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1276819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425340800000",
    "number": "1356662928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2315 STOCKTON BLVD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2315 STOCKTON BLVD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172201",
            "telephone_number": "916-734-0308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "EUNICE",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-18",
        "last_updated": "2015-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A118412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.