Individual provider Active NPI

Florence Kim

  • Family Nurse Practitioner
  • Fullerton, CA
National Provider Identifier
1396122156
Registry record updated Dec 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95002099 Issued in CA
Practice address
1893 W Malvern Ave
Fullerton, CA 92833-2403
Phone
(714) 992-2454
NPI assigned
Apr 30, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95002099 CA Primary

Addresses

Primary practice location

1893 W Malvern Ave
Fullerton, CA 92833-2403

Mailing address

1893 W Malvern Ave
Fullerton, CA 92833-2403
Phone (714) 992-2454

Other practice location 1

710 N Euclid St Ste 400
Anaheim, CA 92801-4132
Phone (714) 517-2000

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150608002926 CA Practitioner - Nurse Practitioner 4789905399 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Oct 23, 2017 Accepting new patients
Southern California Permanente Medical Group CurrentSince Oct 23, 2017 Accepting new patients

Locations

5475 E La Palma Ave
Anaheim, CA 92807
Phone (714) 279-6088

9333 Rosecrans Ave
Bellflower, CA 90706
Phone (562) 461-3340

1893 W Malvern Ave
Fullerton, CA 92833
Phone (714) 278-9022

13200 Jamboree Rd
Irvine, CA 92602
Phone (714) 368-0183

4760 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 783-0567

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

1255 W Arrow Hwy
San Dimas, CA 91773
Phone (909) 394-2526

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1430352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638921600000",
    "number": "1396122156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1893 W MALVERN AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928332403",
            "telephone_number": "714-992-2454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1893 W MALVERN AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928332403",
            "telephone_number": "714-992-2454"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "710 N Euclid St Ste 400",
            "address_purpose": "LOCATION",
            "city": "Anaheim",
            "state": "CA",
            "postal_code": "928014132",
            "country_code": "US",
            "telephone_number": "714-517-2000",
            "fax_number": "714-490-1975",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "FLORENCE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-30",
        "last_updated": "2021-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95002099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4760 W Sunset Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900276063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.