Individual provider Active NPI

Van Kim Ma, MD

  • Developmental - Behavioral Pediatrics Physician
  • Sacramento, CA
National Provider Identifier
1487157699
Registry record updated Nov 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
License
A173790 Issued in CA
Practice address
2825 50TH St
Sacramento, CA 95817-2310
Phone
(916) 703-0300
NPI assigned
Mar 14, 2018
Last updated
Nov 4, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Developmental - Behavioral Pediatrics Physician 2080P0006X A173790 CA Primary

Addresses

Primary practice location

2825 50TH St
Sacramento, CA 95817-2310

Mailing address

2825 50TH St
Sacramento, CA 95817-2310
Phone (916) 703-0280

Other practice location 1

44 Gough St Ste 210
San Francisco, CA 94103-5424
Phone (415) 829-7323

Other practice location 2

201 Lyons Ave
Newark, NJ 07112-2027
Phone (973) 926-7471

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240715001767 CA Practitioner - Pediatric Medicine 5092189530 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A173790CAMDDevelopmental - Behavioral Pediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the Univ of Ca Current Accepting new patients
Regents of the University of Ca CurrentSince Aug 1, 2024 Accepting new patients
Regents of the Univ of Ca CurrentSince Aug 1, 2024 Accepting new patients
Steps Therapy Inc Past Accepting new patients
Regents of the Univ of Ca Past Accepting new patients
Regents of the Univ of Ca Past Accepting new patients

Locations

10850 White Rock Rd
Rancho Cordova, CA 95670

2521 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-1104

2825 50th St
Sacramento, CA 95817
Phone (916) 703-0300

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1520985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635984000000",
    "number": "1487157699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 50TH ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172310",
            "telephone_number": "916-703-0280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 50TH ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172310",
            "telephone_number": "916-703-0300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "44 Gough St Ste 210",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941035424",
            "country_code": "US",
            "telephone_number": "415-829-7323",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 Lyons Ave",
            "address_purpose": "LOCATION",
            "city": "Newark",
            "state": "NJ",
            "postal_code": "071122027",
            "country_code": "US",
            "telephone_number": "973-926-7471",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MA",
        "first_name": "VAN",
        "middle_name": "KIM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-14",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "CA",
            "license": "A173790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.