Wayne W Kim, D.O.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Practice address

12362 Beach Blvd Ste 10
Stanton, CA 90680-3944

Phone

(714) 248-9500

Fax

(714) 622-4943

NPI assigned

Aug 8, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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 and National Provider Directory roles.

• Livingstone Community Development Corporation

  • Federally Qualified Health Center (FQHC)
  • Stanton, CA
  • NPI 1952662686

  Community Health

  Medicare reassignment NPD
• S.F. Medical Center

  • Medical Physician Assistant
  • Spanaway, WA
  • NPI 1194735530

  Family Medicine

  NPD (past) Authorized official
• Livingstone Community Development Corporation

  • Federally Qualified Health Center (FQHC)
  • Fullerton, CA
  • NPI 1881210318

  Family Medicine

  NPD
• Franciscan Medical Group

  • Family Medicine Physician
  • Tacoma, WA
  • NPI 1366539421
  NPD (past)

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1619987054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12362 BEACH BLVD STE 10",
            "city": "STANTON",
            "state": "CA",
            "postal_code": "906803944",
            "telephone_number": "714-248-9500",
            "fax_number": "714-622-4943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12362 BEACH BLVD STE 10",
            "city": "STANTON",
            "state": "CA",
            "postal_code": "906803944",
            "telephone_number": "714-248-9500",
            "fax_number": "714-622-4943"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "144 169th St S Ste A",
            "address_purpose": "LOCATION",
            "city": "Spanaway",
            "state": "WA",
            "postal_code": "983878242",
            "country_code": "US",
            "telephone_number": "253-536-2824",
            "fax_number": "253-536-3070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "WAYNE",
        "middle_name": "W",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP00001562",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "WA",
            "license": "OP00001562",
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heejin Emily Kim, NURSE PRACTITIONER
• Hyun Joo Kim, L.AC.
• Jiah Kim, RN
• Seongjo Kim
• So Hyoung Kim
• Yvett Yoon Kim, FNP
• Kimberly Bao Nguyen, a Dental Corp
• Alondra R R King
• Devon Kishketon
• KLMH Enterprises LLC

• Federally Qualified Health Center (FQHC) in Stanton, CA
• Providers in Stanton, CA by specialty
• Federally Qualified Health Center (FQHC) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; 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.