Pediatric Surgical Associates of the East Bay

Primary specialty

Pediatric Surgery PhysicianTaxonomy code 2086S0120X

Legal business name

PEDIATRIC SURGICAL ASSOCIATES OF THE EAST BAY

Practice address

744 52ND St
Suite 4100
Oakland, CA 94609-1810

Phone

(510) 428-3017

Fax

(510) 428-3405

NPI assigned

Apr 18, 2006

Organization subpart

No

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

Authorized official

Name

Sunghoon Kim, M.D.

Title

Managing Partner

Phone

(510) 428-3017

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305763200000",
    "number": "1619932209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5528 PACHECO BLVD",
            "address_2": "SUITE A",
            "city": "PACHECO",
            "state": "CA",
            "postal_code": "945535154",
            "telephone_number": "925-363-8170",
            "fax_number": "925-363-8178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 52ND ST",
            "address_2": "SUITE 4100",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946091810",
            "telephone_number": "510-428-3017",
            "fax_number": "510-428-3405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SURGICAL ASSOCIATES OF THE EAST BAY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-18",
        "last_updated": "2011-05-19",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SUNGHOON",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "510-428-3017",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Pediatric Surgery",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0086800",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pediatric Contracting Services, Inc.
• Pediatric Hematology Oncology
• Pediatric Imaging Medical Associates
• Pediatric Psychiatric Med Assoc Cho
• Pediatric Rehab Med Assoc
• Annie Rose Pedlar, FNP, DNP
• Andrea Pedraza
• Donna Reimann Pedroza, LCSW
• Sofia Pedroza
• Darren Peech

• Pediatric Surgery Physician in Oakland, CA
• Providers in Oakland, CA by specialty
• Pediatric Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2011; 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.