Individual provider Active NPI

David S Kim, MD

  • Family Medicine Physician
  • Long Beach, CA
National Provider Identifier
1528059607
Registry record updated Jan 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A87971 Issued in CA
Practice address
2110 N Bellflower Blvd
Long Beach, CA 90815-3126
Phone
(562) 346-2222
NPI assigned
Oct 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A87971 CA Primary

Addresses

Primary practice location

2110 N Bellflower Blvd
Long Beach, CA 90815-3126

Mailing address

17360 Brookhurst St
Attn: MCMF Credentialing Department
Fountain Valley, CA 92708-3720

Other identifiers 1

IdentifierTypeStateIssuer
00A879710MedicaidCA

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
I20050601000927 CA Practitioner - Family Practice 7113969098 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A87971CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Jan 4, 2016 Accepting new patients
Providence Medical Foundation Family Medicine CurrentSince Jan 4, 2016 Accepting new patients
Providence Medical Foundation Family Medicine Current Accepting new patients

Locations

200 W Ctr St Promenade
Ste 400
Anaheim, CA 92805

1514 Valley Vista Dr
Diamond Bar, CA 91765
Phone (909) 560-1144

17360 Brookhurst St
Fountain Vly, CA 92708
Phone (657) 241-3592

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Memorialcare Orange Coast Medical CenterFountain Valley, CA, CCN 050678 Hospital Corporate Officer Jul 1, 2026

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452556800000",
    "number": "1528059607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17360 BROOKHURST ST",
            "address_2": "ATTN: MCMF CREDENTIALING DEPARTMENT",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927083720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 N BELLFLOWER BLVD",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908153126",
            "telephone_number": "562-346-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "DAVID",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-28",
        "last_updated": "2016-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A87971",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A879710",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.