Alice Hae Lee Kim, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2843 Piedmont Ave
La Crescenta, CA 91214-3836

Phone

(818) 649-4872

NPI assigned

Apr 24, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Alice Hae Lee Yoon Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Huntington Orthopedic Surgical Group

  • Sports Medicine (Neuromusculoskeletal Medicine) Physician
  • Pasadena, CA
  • NPI 1851465603
  Medicare reassignment

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

{
    "created_epoch": "1524528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729296000000",
    "number": "1548758618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2843 PIEDMONT AVE",
            "city": "LA CRESCENTA",
            "state": "CA",
            "postal_code": "912143836",
            "telephone_number": "818-649-4872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2843 PIEDMONT AVE",
            "city": "LA CRESCENTA",
            "state": "CA",
            "postal_code": "912143836",
            "telephone_number": "818-649-4872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ALICE",
        "middle_name": "HAE LEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-24",
        "last_updated": "2024-10-19",
        "certification_date": "2024-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALICE",
            "last_name": "YOON",
            "middle_name": "HAE LEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• James M Kanda, DDS
• Martik Karapetyan
• Sonia Kazandjian, MFT
• Sara Kendryna
• Anoush Ketsoyan
• Byung Joe Kim
• Ida Kim
• Johanna Minji Kim
• Justin Minjoo Kim, DPT
• Samuel Kim, D.D.S

• Physician Assistant in La Crescenta, CA
• Providers in La Crescenta, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2024; 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.

Verify at the official NPI Registry.