Individual provider Active NPI

Catherine Jin, MD

  • Pediatrics Physician
  • Orange, CA
National Provider Identifier
1639580889
Registry record updated Jan 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A140485 Issued in CA
Practice address
505 S Main St Ste 525
Orange, CA 92868-4553
Phone
(330) 990-9502
NPI assigned
May 9, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A140485 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

505 S Main St Ste 525
Orange, CA 92868-4553

Mailing address

505 S Main St Ste 525
Orange, CA 92868-4553
Phone (330) 990-9502

Other practice location 1

881 Alma Real Dr Ste 316
Pacific Palisades, CA 90272-5061
Phone (310) 454-2296

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20220107001428 CA Practitioner - Pediatric Medicine 7618275074 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
140485CAMDMarriage & Family Therapist
A140485CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Saint Johns Medical Foundation CurrentSince Jan 14, 2022 Accepting new patients
Providence Saint Johns Medical Foundation Pediatrics CurrentSince Jan 14, 2022 Accepting new patients
Providence Saint John'S Health Center Past Accepting new patients
Saint John'S Health Clinic Past Accepting new patients

Locations

881 Alma Real Dr
Ste 316
Pacific Plsds, CA 90272
Phone (310) 454-1317

2121 Santa Monica Blvd
Santa Monica, CA 90404
Phone (310) 281-2024

2021 Santa Monica Blvd
Ste 245E
Santa Monica, CA 90404
Phone (310) 829-4403

2336 Santa Monica Blvd
Ste 204
Santa Monica, CA 90404
Phone (310) 453-4477

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: cjin868414@oc.providencedirect.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1399593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705622400000",
    "number": "1639580889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 S MAIN ST STE 525",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684553",
            "telephone_number": "330-990-9502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 S MAIN ST STE 525",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684553",
            "telephone_number": "330-990-9502"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "881 Alma Real Dr Ste 316",
            "address_purpose": "LOCATION",
            "city": "Pacific Palisades",
            "state": "CA",
            "postal_code": "902725061",
            "country_code": "US",
            "telephone_number": "310-454-2296",
            "fax_number": "310-454-2295",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JIN",
        "first_name": "CATHERINE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-09",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A140485",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.