Ivan Kim, MD, MA

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

A195501 Issued in CA

Practice address

11234 Anderson St
Loma Linda, CA 92354-2804

Phone

(909) 558-4015

NPI assigned

Apr 8, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Specialty

Anesthesiology

Education

Loma Linda University School of Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Faculty Physicians and Surgeons of LlusmGroup PAC ID 1153227814, shared by 6 NPIs, 1,313 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Riverside University Health System-Medical Center Hospital, Moreno Valley, CA, CCN 050292

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Doctor of Medicine

State licenses

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• County of Riverside

  • General Acute Care Hospital
  • Moreno Valley, CA
  • NPI 1821159195
  Care Compare affiliation

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

{
    "created_epoch": "1617840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780272000000",
    "number": "1477132173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26520 CACTUS AVE",
            "address_2": "DEPARTMENT OF ANESTHESIOLOGY",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "92555",
            "telephone_number": "951-486-5293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542804",
            "telephone_number": "909-558-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "IVAN",
        "name_prefix": "Dr.",
        "credential": "MD, MA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-08",
        "last_updated": "2026-06-01",
        "certification_date": "2026-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A195501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Kim
• Hee Won Kim
• Hyemin Kim, MD
• Hyungjin Benjamin Kim, D.O.
• Hyunsoo Kim, PHARMD
• Jayden Jaeok Kim, DDS
• Jeffrey L. Kim, M.D.
• Jeong Mi Kim, R.N., C.R.N.A.
• Jessica Junghwa Kim, DDS
• Jinseong Kim

• Anesthesiology Physician in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2026; 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.