Individual provider Active NPI

John Albert Kim, MD

  • Emergency Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1659321628
Registry record updated Jun 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
170537 Issued in CA
Practice address
12665 Village LN Apt 2314
Los Angeles, CA 90094-2833
Phone
(412) 414-3498
NPI assigned
May 11, 2006
Last updated
Jun 29, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 170537 CA Primary

Addresses

Primary practice location

12665 Village LN Apt 2314
Los Angeles, CA 90094-2833

Mailing address

12665 Village LN Apt 2314
Los Angeles, CA 90094-2833
Phone (412) 414-3498

Other identifiers 1

IdentifierTypeStateIssuer
101149505MedicaidPA

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)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
170537CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Associates P.a., P.C. Emergency Medicine Past Accepting new patients
Englewood Medical Associates Inc Emergency Medicine Past Accepting new patients
Emergency Medicine Associates Emergency Medicine Past Accepting new patients
Medical Associates of Englewood, PC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: john.kim.1@24265.direct.athenahealth.com
  • Direct secure messaging: john.kim.1@25843.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656460800000",
    "number": "1659321628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12665 VILLAGE LN APT 2314",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900942833",
            "telephone_number": "412-414-3498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12665 VILLAGE LN APT 2314",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900942833",
            "telephone_number": "412-414-3498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JOHN",
        "middle_name": "ALBERT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "170537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101149505",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.