Jessica Wiedemann Kim, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95004967 Issued in CA

Practice address

12900 Park Plaza Dr
Suite #150
Cerritos, CA 90703-9329

Phone

(800) 499-2793

NPI assigned

Sep 14, 2016

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

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1473811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476748800000",
    "number": "1366990798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12900 PARK PLAZA DR",
            "address_2": "SUITE #150",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907039329",
            "telephone_number": "800-499-2793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12900 PARK PLAZA DR",
            "address_2": "SUITE #150",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907039329",
            "telephone_number": "800-499-2793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JESSICA",
        "middle_name": "WIEDEMANN",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-14",
        "last_updated": "2016-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95004967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ethan Daniel Sung Soo Kim
• Eui Kyoung Kim
• Grace Kim, FNP-C
• Haley Kim, MA
• Jennifer Jihye Kim
• John Shin Kim, M.D.
• Kasey Kim, MD
• Kyu Boom Kim, D.C.
• Lanchi Vu Kim, M.S.
• Lloyd Kim, LMFT

• Family Nurse Practitioner in Cerritos, CA
• Providers in Cerritos, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2016; 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.

Verify at the official NPI Registry.