Kungsoo Kim, M.D.

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

A47842 Issued in CA

Practice address

18102 Pioneer Blvd
#201
Artesia, CA 90701-3953

Phone

(562) 865-8537

Fax

(562) 860-0952

NPI assigned

Apr 10, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Anaheim Memorial Medical Center

  • General Acute Care Hospital
  • Anaheim, CA
  • NPI 1295782381
  NPD (past)
• Long Beach Memorial Medical

  • Rehabilitation Hospital Unit
  • Long Beach, CA
  • NPI 1396791414
  NPD (past)

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306972800000",
    "number": "1467415455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18102 PIONEER BLVD",
            "address_2": "#201",
            "city": "ARTESIA",
            "state": "CA",
            "postal_code": "907013953",
            "telephone_number": "562-865-8537",
            "fax_number": "562-860-0952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18102 PIONEER BLVD",
            "address_2": "#201",
            "city": "ARTESIA",
            "state": "CA",
            "postal_code": "907013953",
            "telephone_number": "562-865-8537",
            "fax_number": "562-860-0952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "KUNGSOO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-10",
        "last_updated": "2011-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CA",
            "license": "A47842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A478420",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eun Young Kim
• Eunice E Kim, DPM
• Hyoung Wook Kim, DDS
• Iljoon Kim, DMD
• John Sang Min Kim
• Namgu Kim
• Roseann Knight
• Samuel Jinwook Ko, LIC, AC.
• Carole Kochi, D.C.
• Tahereh Korhani, D.D.S

• Pediatric Adolescent Medicine Physician in Artesia, CA
• Providers in Artesia, CA by specialty
• Pediatric Adolescent Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.