Individual provider Active NPI

Tommy Youngho Kim, M.D.

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Loma Linda, CA
National Provider Identifier
1730172693
Registry record updated Jul 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
A74005 Issued in CA
Practice address
11234 Anderson St
A 108
Loma Linda, CA 92354-2804
Phone
(909) 558-4000
NPI assigned
Aug 25, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X A74005 CA Primary

Addresses

Primary practice location

11234 Anderson St
A 108
Loma Linda, CA 92354-2804

Mailing address

11234 Anderson St
A 108
Loma Linda, CA 92354-2804
Phone (909) 558-4000

Other identifiers 1

IdentifierTypeStateIssuer
Z72778MedicaidUT

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
I20040624001081 CA Practitioner - Emergency Medicine 5294711073 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
96.69 of 100Reported as group
Quality
90
Improvement activities
40
Cost
78.43

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A74005CAMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California Current Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Aug 5, 2019 Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Aug 5, 2019 Accepting new patients
Faculty Physicians and Surgeons of Llusm Past Accepting new patients
Riverside Healthcare System, L.P. Past Accepting new patients
St. Joseph Hospital Past Accepting new patients
Emergency Medicine Specialists of Orange County Past Accepting new patients
Loma Linda University Medical Center Past Accepting new patients
Little Company of Mary Affiliated Services Inc Past Accepting new patients
Loma Linda University Children'S Hospital Past Accepting new patients

Locations

2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777

11234 Anderson St
#A108
Loma Linda, CA 92350
Phone (714) 770-3564

11234 Anderson St
Loma Linda, CA 92350
Phone (909) 558-3016

11234 Anderson St
#108
Loma Linda, CA 92350
Phone (909) 558-4344

25455 Barton Rd
Ste 108A
Loma Linda, CA 92354
Phone (909) 558-1617

11370 Anderson St
#B100
Loma Linda, CA 92354
Phone (909) 558-2848

11234 Anderson St
Rm A108
Loma Linda, CA 92350
Phone (909) 558-4085

File 54701
Los Angeles, CA 90074
Phone (909) 651-4300

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

28078 Baxter Rd
Murrieta, CA 92563
Phone (951) 290-4000

Organizations & group practices 11

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": "1124928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279497600000",
    "number": "1730172693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST",
            "address_2": "A 108",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542804",
            "telephone_number": "909-558-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST",
            "address_2": "A 108",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542804",
            "telephone_number": "909-558-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "TOMMY",
        "middle_name": "YOUNGHO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-25",
        "last_updated": "2010-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "CA",
            "license": "A74005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z72778",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.