Active NPI
Chung Won Kim
- Nurse Practitioner
- Fountain Valley, CA
National Provider Identifier
1386070894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 21840
- Practice address
- 11190 Warner Ave Ste 300
Fountain Valley, CA 92708-4045 - Phone
- (714) 893-6008
- NPI assigned
- Sep 17, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 21840 | CA | Primary |
| Acute Care Nurse Practitioner | 363LA2100X | 21840 | CA |
Addresses
Primary practice location
11190 Warner Ave Ste 300
Fountain Valley, CA 92708-4045
Mailing address
11190 Warner Ave Ste 300
Fountain Valley, CA 92708-4045
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21840 | CA | MD | Acute Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1379376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405555200000",
"number": "1386070894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11190 WARNER AVE STE 300",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927084045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11190 WARNER AVE STE 300",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927084045",
"telephone_number": "714-893-6008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "CHUNG",
"middle_name": "WON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-09-17",
"last_updated": "2014-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "21840",
"primary": true
},
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "CA",
"license": "21840",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fountain Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.