Myungjin Kim, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

29866 Issued in CA

Practice address

12139 Mount Vernon Ave
Suite 110
Grand Terrace, CA 92313-5586

Phone

(909) 370-3396

Fax

(909) 783-4288

NPI assigned

Mar 2, 2011

Last updated

Sep 19, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2001

Medicare assignment

May accept Medicare assignment

Group practices

Total Care Physical Therapy IncGroup PAC ID 9830341767, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Total Care Physical Therapy Inc.

  • Physical Therapy Clinic/Center
  • Colton, CA
  • NPI 1831441054
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1299024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348012800000",
    "number": "1578861399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12139 MOUNT VERNON AVE",
            "address_2": "SUITE 110",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135586",
            "telephone_number": "909-370-3396",
            "fax_number": "909-783-4288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12139 MOUNT VERNON AVE",
            "address_2": "SUITE 110",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135586",
            "telephone_number": "909-370-3396",
            "fax_number": "909-783-4288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MYUNGJIN",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-03-02",
        "last_updated": "2012-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "29866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sokdina Keo
• Keough Chiropractic, Inc
• Kelly Patrick Keough, D.C.
• Keystone NPS LLC
• Cheong Kim, PT
• Cassidy Carina Liu Koo
• Emily Ruth Larsen, SLP
• Michael Anthony Lauw, PHARMD
• Matthew Lawantoro
• Sydney Layvas

• Physical Therapist in Grand Terrace, CA
• Providers in Grand Terrace, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.