Alyssa Youngjee Kim MD a Prof Corp

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

G 70663 Issued in CA

Legal business name

ALYSSA YOUNGJEE KIM MD A PROF CORP

Practice address

14150 Culver Dr
Suite 304
Irvine, CA 92604-0315

Phone

(949) 786-0908

Fax

(949) 786-0970

NPI assigned

Jun 18, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Alyssa Y. Kim, M.D.NPI 1629265772

Title

Medical Director

Phone

(949) 786-0908

Specialties & licenses 4

Addresses

Other names 1

• Alyssa Youngjee Kim, M.D., a Professional Corporation Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alyssa Y. Kim, M.D.

  • Dermatology Physician
  • Irvine, CA
  • NPI 1629265772
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402617600000",
    "number": "1730124306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6521 E YOSEMITE AVE",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928672469",
            "telephone_number": "949-786-0908",
            "fax_number": "714-998-7314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14150 CULVER DR",
            "address_2": "SUITE 304",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926040315",
            "telephone_number": "949-786-0908",
            "fax_number": "949-786-0970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALYSSA YOUNGJEE KIM MD A PROF CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2014-06-13",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "ALYSSA",
        "authorized_official_middle_name": "Y.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "949-786-0908",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G 70663",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "G70663",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "CA",
            "license": "G 70663",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "G 70663",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alyssa Youngjee Kim, M.D., a Professional Corporation",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Dermatology Physician in Irvine, CA
• Providers in Irvine, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.