Kimberley I Shine M D Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A76961 Issued in CA

Legal business name

KIMBERLEY I SHINE M D INC

Practice address

960 E Green St Ste 206
Pasadena, CA 91106-2401

Phone

(626) 222-8636

Fax

(626) 317-0192

NPI assigned

Apr 18, 2016

Organization subpart

No

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

Authorized official

Name

Kimberley I Shine, MDNPI 1598724114

Title

Owner

Phone

(626) 222-8636

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kimberley Irene Shine, MD

  • Family Medicine Physician
  • Pasadena, CA
  • NPI 1598724114

  CA

  Medicare reassignment Authorized official
• Paulina Marie Acevedo, PA-C

  • Physician Assistant
  • Glendale, CA
  • NPI 1306364518

  CA

  Medicare reassignment

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

{
    "created_epoch": "1460937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721001600000",
    "number": "1376997221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 E GREEN ST STE 206",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911062401",
            "telephone_number": "626-222-8636",
            "fax_number": "626-317-0192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 E GREEN ST STE 206",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911062401",
            "telephone_number": "626-222-8636",
            "fax_number": "626-317-0192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBERLEY I SHINE M D INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-18",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A",
        "authorized_official_last_name": "SHINE",
        "authorized_official_first_name": "KIMBERLEY",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "626-222-8636",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A76961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sunghu Kim, LAC
• Susie Young Kim, MD
• Young Ji Jenice Kim, M.D.
• Yuri Kim, D.O.
• Marnetta Kimbell
• Kimberly a Ebner DDS Inc
• Kimberly Foon, DDS
• Kimberly J. Bozart, Physical Therapy, a Professional Corporation
• Alexis May Kimble, D.O.
• Bobby Nathaniel Kimble II

• All providers in Pasadena, CA
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.