John Hwan Kim Evergreen Medical Group

Primary specialty

SpecialistTaxonomy code 174400000X

License

PT14527 Issued in CA

Legal business name

JOHN HWAN KIM EVERGREEN MEDICAL GROUP

Practice address

18555 Farjardo Street
Rowland Heights, CA 91748-4634

Phone

(626) 831-1149

NPI assigned

Aug 9, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Kim

Title

President

Phone

(626) 831-1149

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Estella H Recreo, P.T.

  • Physical Therapist
  • Diamond Bar, CA
  • NPI 1437222924
  NPD (past)

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376553651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18555 FARJARDO STREET",
            "city": "ROWLAND HEIGHTS",
            "state": "CA",
            "postal_code": "917484634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18555 FARJARDO STREET",
            "city": "ROWLAND HEIGHTS",
            "state": "CA",
            "postal_code": "917484634",
            "telephone_number": "626-831-1149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN HWAN KIM EVERGREEN MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-831-1149"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "PT14527",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPIN",
            "identifier": "WPT14527A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Rowland Heights, CA
• Providers in Rowland Heights, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.