Active NPI
Kirsten M Kim, PA-C
- Physician Assistant
- Fountain Valley, CA
National Provider Identifier
1629403647
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 53423
- Practice address
- 11190 Warner Ave Ste 307
Fountain Valley, CA 92708-4047 - Phone
- (714) 434-3518
- NPI assigned
- Sep 10, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 53423 | CA | Primary |
Addresses
Primary practice location
11190 Warner Ave Ste 307
Fountain Valley, CA 92708-4047
Mailing address
11190 Warner Ave Ste 307
Fountain Valley, CA 92708-4047
Phone (714) 434-3518
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53423 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776902400000",
"number": "1629403647",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11190 WARNER AVE STE 307",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927084047",
"telephone_number": "714-434-3518"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11190 WARNER AVE STE 307",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927084047",
"telephone_number": "714-434-3518"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "KIRSTEN",
"middle_name": "M",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-09-10",
"last_updated": "2026-04-23",
"certification_date": "2026-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "53423",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fountain Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2026; 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.