Mina Kim Wasson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

C167860 Issued in CA

Practice address

12395 El Camino Real Ste 219
San Diego, CA 92130-3084

Phone

(858) 793-1011

Fax

(858) 793-1035

NPI assigned

Jun 28, 2010

Last updated

Aug 12, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mina Kim Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Children's Primary Care Medical Group, Inc.

  • Pediatrics Physician
  • San Diego, CA
  • NPI 1184788291

  Single Specialty

  NPD (past)
• Marilyn Kaufhold, M.D., a Medical Corporation

  • Children's Hospital
  • San Diego, CA
  • NPI 1336359389
  NPD (past)
• Rady Children's Hospital San Diego

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • San Diego, CA
  • NPI 1851303994
  NPD (past)
• Daniel Weissbluth, M.D, S.C

  dba Weissbluth Pediatrics

  • Pediatrics Physician
  • Chicago, IL
  • NPI 1710239439

  Single Specialty

  NPD (past)
• Northwestern Memorial Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1578672895
  NPD (past)
• Northwestern Memorial Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1861609208
  NPD (past)

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

{
    "created_epoch": "1277683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597190400000",
    "number": "1366753022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3880 MURPHY CANYON RD STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234411",
            "telephone_number": "858-636-4300",
            "fax_number": "858-636-4319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12395 EL CAMINO REAL STE 219",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921303084",
            "telephone_number": "858-793-1011",
            "fax_number": "858-793-1035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASSON",
        "first_name": "MINA",
        "middle_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-28",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "C167860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MINA",
            "last_name": "KIM",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jack Wasserman, M.D.
• Jessica Wasserman
• Linda M Wasserman, M.D.
• Travis Paul Wasserman
• Werner Peter Wassileff, RN
• Nicholas Ryan Wasson, M.D.
• Lisa J Wastila, M.D.
• Angela Wastrack, LCSW
• Nami Watanabe, DNP, MPH, FNP-BC
• Noriko Watanabe, PSYD

• Pediatrics Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; 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.