Active NPI
Keun-Suh Kim
- General Practice Physician
- Colton, CA
National Provider Identifier
1669925285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- A129431
- Practice address
- 2141 Hill CT
Colton, CA 92324-9512 - Phone
- (909) 501-4730
- NPI assigned
- Aug 1, 2016
- 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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | A129431 | CA | Primary |
Addresses
Primary practice location
2141 Hill CT
Colton, CA 92324-9512
Mailing address
2141 Hill CT
Colton, CA 92324-9512
Phone (909) 501-4730
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A129431 | CA | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470009600000",
"number": "1669925285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2141 HILL CT",
"city": "COLTON",
"state": "CA",
"postal_code": "923249512",
"telephone_number": "909-501-4730"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2141 HILL CT",
"city": "COLTON",
"state": "CA",
"postal_code": "923249512",
"telephone_number": "909-501-4730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "KEUN-SUH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-08-01",
"last_updated": "2016-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "CA",
"license": "A129431",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.