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

Last updated

Jul 15, 2024By 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

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, and the practitioner matching its NPPES authorized official.

• Kimberley Irene Shine, MD

  • Family Medicine Physician
  • Pasadena, CA
  • NPI 1598724114
  Medicare reassignment Authorized official
• Paulina Marie Acevedo, PA-C

  • Physician Assistant
  • Glendale, CA
  • NPI 1306364518
  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 (Accelerated Sports Medicine & Physical Therapy)
• Alexis May Kimble, D.O.
• Bobby Nathaniel Kimble II

• Family Medicine Physician in Pasadena, CA
• Providers in Pasadena, CA by specialty
• 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.