NPIMap

Individual provider Active NPI

Chin SE Kim, M.D.

  • Sports Medicine (Neuromusculoskeletal Medicine) Physician
  • Anaheim, CA
National Provider Identifier
1477564607
Registry record updated May 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X
License
A46079 Issued in CA
Practice address
1736 W Medical Center Dr
Suite B
Anaheim, CA 92801-1854
Phone
(714) 520-0809
Fax
(714) 520-0835
NPI assigned
Aug 11, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 5, 2008

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Neuromusculoskeletal Medicine) Physician 204C00000X A46079 CA Primary
Internal Medicine Physician 207R00000X A46079 CA
Sports Medicine (Internal Medicine) Physician 207RS0010X A46079 CA
Pain Medicine Physician 208VP0000X A46079 CA

Addresses

Primary practice location

1736 W Medical Center Dr
Suite B
Anaheim, CA 92801-1854

Mailing address

1736 W Medical Center Dr
Suite B
Anaheim, CA 92801-1854
Phone (714) 520-0809

Other identifiers 1

IdentifierTypeStateIssuer
00A46079MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050616000376 CA Practitioner - Internal MedicinePractitioner - Sports MedicinePractitioner - Pain Management 8224072608 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Sports Medicine
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1736 W Medical Ctr Dr
Suite B
Anaheim, CA 92801-1854
Phone (714) 520-0809

Hospital & facility affiliations

  • Ace Home Health, Inc. Home health agency, Los Angeles, CA, CCN 058082
  • Good People Home Health, Inc. Home health agency, Fullerton, CA, CCN 757253
  • Divine Home Health, Inc Home health agency, La Mirada, CA, CCN 058330
  • Cross Care, Inc Home health agency, Los Angeles, CA, CCN 059383
  • Greenfield Care Center of Fullerton, LLC Nursing home, Fullerton, CA, CCN 056151
  • Buena Park Nursing Center Nursing home, Buena Park, CA, CCN 055571

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
100
Improvement activities
40
Cost
76.54

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue19
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles (6 of 7)

OrganizationSpecialtyStatusNew patients
Chin SE Kim, MD Inc Sports Medicine CurrentSince Jul 1, 2003 Accepting new patients
Oracle Imaging Inc. CurrentSince May 8, 2020 Accepting new patients
Mission Hospital Regional Medical Center Past Accepting new patients
Unicare Surgery Center Inc. PastSince Jul 28, 2014 Accepting new patients
Healthcare Partners Affiliates Medical Group Neuromusculoskeletal Medicine, Sports Medicine Past Accepting new patients
Dignity Community Care Past Accepting new patients

Locations

1736 W Medical Center Dr
Ste B
Anaheim, CA 92801
Phone (714) 520-0809

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: chin.kim@279204627808260.direct.elationemr.com

Organizations & group practices 6

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209945600000",
    "number": "1477564607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1736 W MEDICAL CENTER DR",
            "address_2": "SUITE B",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928011854",
            "telephone_number": "714-520-0809",
            "fax_number": "714-520-0835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1736 W MEDICAL CENTER DR",
            "address_2": "SUITE B",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928011854",
            "telephone_number": "714-520-0809",
            "fax_number": "714-520-0835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHIN",
        "middle_name": "SE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2008-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "CA",
            "license": "A46079",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A46079",
            "primary": false
        },
        {
            "code": "207RS0010X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sports Medicine",
            "state": "CA",
            "license": "A46079",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "CA",
            "license": "A46079",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A46079",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.