Mideum Timothy Kim, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP95024886 Issued in CA

Practice address

2776 Pacific Ave
Long Beach, CA 90806-2613

Phone

(562) 997-2049

Fax

(562) 595-6985

NPI assigned

May 5, 2023

Sex

Male

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

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

B and K Health Care PCGroup PAC ID 4284164062, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• B and K Health Care PC

  • Psychiatric/Mental Health Nurse Practitioner
  • Anaheim, CA
  • NPI 1477362952
  Medicare reassignment Care Compare group NPD Authorized official
• Global Transitional Care, LLC

  • Specialist
  • Costa Mesa, CA
  • NPI 1245630607
  Medicare reassignment NPD
• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846
  Medicare reassignment NPD
• Southland Renal Medical Group, Inc.

  • Nephrology Physician
  • Los Alamitos, CA
  • NPI 1205969748
  NPD (past)
• Southland Renal Medical Group, Inc.

  • Nephrology Physician
  • Long Beach, CA
  • NPI 1730110495
  NPD (past)

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

{
    "created_epoch": "1683244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1386333151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2776 PACIFIC AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908062613",
            "telephone_number": "562-997-2049",
            "fax_number": "562-595-6985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2776 PACIFIC AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908062613",
            "telephone_number": "562-997-2049",
            "fax_number": "562-595-6985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MIDEUM",
        "middle_name": "TIMOTHY",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-05",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95024886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsey Kim, DNP, APRN, FNP-BC
• May Kim, PH.D.
• Melvie Kim, MD
• Michelle Elizabeth Kim, M.D.
• Michelle Heejin Kim
• Min Kyoung Kim, PHARMD
• Mira Kim
• Monica Kim, M.D.
• Monthor Rene Kim, OTR
• Patrick Kim, D.C.

• Family Nurse Practitioner in Long Beach, CA
• Providers in Long Beach, 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 16, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.