John J Kim, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

A29493 Issued in CA

Practice address

629 N 13TH Ave
Upland, CA 91786-4906

Phone

(909) 981-8905

Fax

(909) 982-8051

NPI assigned

May 5, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. John Jae-Dong Kim Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466985600000",
    "number": "1548218274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 N 13TH AVE",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864906",
            "telephone_number": "909-981-8905",
            "fax_number": "909-982-8051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 N 13TH AVE",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864906",
            "telephone_number": "909-981-8905",
            "fax_number": "909-982-8051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JOHN",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2016-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A29493",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "A29493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOHN",
            "last_name": "KIM",
            "middle_name": "JAE-DONG",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Filmon Kifle, DDS
• Bradford James Kim, M.D.
• Jennifer Young-Hee Kim, M.D.
• Ji Young Kim
• John H Kim, DDS
• Jong Wan Kim
• Junghwa Kim
• Moon Jeong Kim
• Myungsoon Kim, L.AC.
• Samuel C. Kim, MD

• Gastroenterology Physician in Upland, CA
• Providers in Upland, CA by specialty
• Gastroenterology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.