Rhodora Estacio Kim, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A71519 Issued in CA

Practice address

18460 Roscoe Blvd
Northridge, CA 91325-4107

Phone

(818) 837-5790

Fax

(818) 998-2506

NPI assigned

Jul 18, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rkim350136@oc.providencedirect.org

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.

• Providence Facey Medical Foundation

  dba Facey Medical Group

  • Internal Medicine Physician
  • Valencia, CA
  • NPI 1710031588

  Pediatrics

  Medicare reassignment NPD
• Providence Facey Medical Foundation

  dba Providence Express Care

  • Multi-Specialty Clinic/Center
  • Irvine, CA
  • NPI 1891348447
  NPD
• Providence Facey Medical Foundation

  dba Facey Endoscopy Center

  • Ambulatory Surgical Clinic/Center
  • Mission Hills, CA
  • NPI 1194083824
  NPD (past)
• Scotland County Memorial Hospital Dba Wyaconda Medical Services

  • Family Medicine Physician
  • Wyaconda, MO
  • NPI 1154529733
  NPD (past)
• Scotland County Memorial Hosptial

  • Critical Access Hospital
  • Memphis, MO
  • NPI 1841364585
  NPD (past)

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618444800000",
    "number": "1750309365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9602",
            "city": "MISSION HILLS",
            "state": "CA",
            "postal_code": "913469602",
            "telephone_number": "818-837-5691",
            "fax_number": "818-792-4793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18460 ROSCOE BLVD",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913254107",
            "telephone_number": "818-837-5790",
            "fax_number": "818-998-2506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "RHODORA",
        "middle_name": "ESTACIO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A71519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A715190",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rkim350136@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "9111 Corbin Ave",
            "city": "Northridge",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913242402",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gene S Kim, PHARM.D.
• Grace Kim, NURSE PRACTITIONER
• Jin Kook Kim, LAC
• Joo Kim, ACUPUNCTURIST
• Misun Michelle Kim, PHARM.D
• Steve Kim, PHARM. D.
• Young Han Kim, O.M.D.
• Young Mi Kim, LCSW
• Young Tae Kim, LAC
• Devon Kimball

• Pediatrics Physician in Northridge, CA
• Providers in Northridge, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2021; 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.

Verify at the official NPI Registry.