Active NPI
Saekyu Robert Kim, M.D.
- Urology Physician
- Yreka, CA
National Provider Identifier
1629033535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- MD00042435
- Practice address
- 475 Bruce St
Yreka, CA 96097-3474 - Phone
- (530) 841-6313
- Fax
- (530) 841-6334
- NPI assigned
- Apr 20, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Urology Physician | 208800000X | MD00042435 | WA | Primary |
Addresses
Primary practice location
475 Bruce St
Yreka, CA 96097-3474
Mailing address
444 Bruce St
Yreka, CA 96097-3450
Phone (530) 841-6313
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CG054Z | Other | CA | PTAN MEDICARE |
| 1629033535 | Medicaid | CA | |
| 1118645 | Medicaid | WA |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| East Bay Surgical Associates, a Medical Corporation | Past | Accepting new patients | |
| Bass Medical Group | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Specialist
- Walnut Creek, CA
- NPI 1154401941
-
- Surgery Physician
- Antioch, CA
- NPI 1689858748
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257984000000",
"number": "1629033535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "444 BRUCE ST",
"city": "YREKA",
"state": "CA",
"postal_code": "960973450",
"telephone_number": "530-841-6313",
"fax_number": "530-841-6334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "475 BRUCE ST",
"city": "YREKA",
"state": "CA",
"postal_code": "960973474",
"telephone_number": "530-841-6313",
"fax_number": "530-841-6334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SAEKYU",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-20",
"last_updated": "2009-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "WA",
"license": "MD00042435",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN MEDICARE",
"identifier": "CG054Z",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1629033535",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1118645",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yreka, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.