Active NPI
Tchang Jun Kim, MD
- Anesthesiology Physician
- Garden Grove, CA
National Provider Identifier
1629011366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- A29337
- Practice address
- 12900 A Garden Grove Blvd
Ste #122
Garden Grove, CA 92842 - Phone
- (714) 636-0342
- Fax
- (714) 636-0391
- NPI assigned
- Jun 13, 2006
- Last updated
- Aug 22, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | A29337 | CA | Primary |
Addresses
Primary practice location
12900 A Garden Grove Blvd
Ste #122
Garden Grove, CA 92842
Mailing address
PO Box 775
12900A Garden Grove Blvd Ste #122
Garden Grove, CA 92842
Phone (714) 636-0242
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A293370 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A29337 | CA | MD | Anesthesiology Physician |
| 29337 | CA | MD | Physical Therapist |
Organizations & group practices 1
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.
-
- Anesthesiology Physician
- Garden Grove, CA
- NPI 1629267943
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408665600000",
"number": "1629011366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 775",
"address_2": "12900A GARDEN GROVE BLVD STE #122",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "92842",
"telephone_number": "714-636-0242",
"fax_number": "714-636-0291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12900 A GARDEN GROVE BLVD",
"address_2": "STE #122",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "92842",
"telephone_number": "714-636-0342",
"fax_number": "714-636-0391"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "TCHANG",
"middle_name": "JUN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-13",
"last_updated": "2014-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "CA",
"license": "A29337",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A293370",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Garden Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.