Active NPI
Kathleen Kim, M.D.
- Psychiatry Physician
- San Diego, CA
National Provider Identifier
1710902739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- G86882
- Practice address
- 3350 La Jolla Village Dr
M/C 116a
San Diego, CA 92161-0002 - Phone
- (858) 552-8585
- Fax
- (858) 642-6442
- NPI assigned
- Jul 12, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | G86882 | CA | Primary |
Addresses
Primary practice location
3350 La Jolla Village Dr
M/C 116a
San Diego, CA 92161-0002
Mailing address
PO Box 7143
Rancho Santa Fe, CA 92067-7143
Phone (858) 759-4052
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036090635 | Medicaid | IL |
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: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710902739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7143",
"city": "RANCHO SANTA FE",
"state": "CA",
"postal_code": "920677143",
"telephone_number": "858-759-4052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3350 LA JOLLA VILLAGE DR",
"address_2": "M/C 116A",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921610002",
"telephone_number": "858-552-8585",
"fax_number": "858-642-6442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "KATHLEEN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "G86882",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036090635",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.