Active NPI
Il Young Kim, M.D.
- Cardiovascular Disease Physician
- Los Angeles, CA
National Provider Identifier
1447288543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- A33707
- Practice address
- 3919 Beverly Blvd
#100
Los Angeles, CA 90004-3432 - Phone
- (323) 662-1175
- Fax
- (323) 662-7817
- NPI assigned
- Jun 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | A33707 | CA | Primary |
Addresses
Primary practice location
3919 Beverly Blvd
#100
Los Angeles, CA 90004-3432
Mailing address
3919 Beverly Blvd
#100
Los Angeles, CA 90004
Phone (323) 662-1175
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A33707 | Medicaid | CA |
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100724000229 | CA | Practitioner - Cardiovascular Disease (Cardiology) | 8325170459 |
Care Compare profile
Medicare Care Compare- Specialty
- Cardiovascular Disease (Cardiology)
- Education
- Other, 1971
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
3919 Beverly Blvd
Suite 100
Los Angeles, CA 90004-3432
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A33707 | CA | MD | Cardiovascular Disease Physician |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216339200000",
"number": "1447288543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3919 BEVERLY BLVD",
"address_2": "#100",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90004",
"telephone_number": "323-662-1175",
"fax_number": "323-662-7817"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3919 BEVERLY BLVD",
"address_2": "#100",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900043432",
"telephone_number": "323-662-1175",
"fax_number": "323-662-7817"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "IL",
"middle_name": "YOUNG",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-28",
"last_updated": "2008-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "CA",
"license": "A33707",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "A33707",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2008; 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.