Active NPI
Stephen Y Kim, D.C.
- Chiropractor
- San Diego, CA
National Provider Identifier
1508152133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC 24449
- Practice address
- 7750 Dagget St
Suite 105
San Diego, CA 92111-2234 - Phone
- (858) 717-6120
- Fax
- (858) 565-4377
- NPI assigned
- Jun 22, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC 24449 | CA | Primary |
Addresses
Primary practice location
7750 Dagget St
Suite 105
San Diego, CA 92111-2234
Mailing address
11326 Creekstone LN
San Diego, CA 92128-6329
Phone (858) 717-6120
Other names 1
- Stephen Kim
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201117000279 | CA | Practitioner - Chiropractic | 3971914334 | Practice locations: San Diego, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC 24449 | CA | MD | Chiropractor |
| 24449 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372032000000",
"number": "1508152133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11326 CREEKSTONE LN",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921286329",
"telephone_number": "858-717-6120",
"fax_number": "858-565-4377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7750 DAGGET ST",
"address_2": "SUITE 105",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921112234",
"telephone_number": "858-717-6120",
"fax_number": "858-565-4377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "STEPHEN",
"middle_name": "Y",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-22",
"last_updated": "2013-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC 24449",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "STEPHEN",
"last_name": "KIM",
"credential": "LAC.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2013; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.