Lydia R Kim, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A150150 Issued in CA

Practice address

7373 West LN Ste 355
Stockton, CA 95210-3377

Phone

(209) 476-2166

NPI assigned

Apr 5, 2013

Last updated

Dec 17, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Dermatology

Education

University of Wisconsin School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Medical InstituteGroup PAC ID 5991609737, 303 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

96.26 of 100Reported as apm

Quality

84.3

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

93.97 of 100Reported as group

Quality

100

Improvement activities

40

Cost

79.9

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Providence Medical Institute

  dba Providence Little Company of Mary Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1417915760

  Dermatology

  Medicare reassignment Care Compare group NPD
• Malcolm Ke, M.D., a Professional Corporation

  dba Clear Dermatology

  • Dermatology Physician
  • Torrance, CA
  • NPI 1225350069
  Medicare reassignment NPD
• Dr. a.R. Bhupathy, Inc

  • Dermatology Physician
  • Loma Linda, CA
  • NPI 1902907108
  NPD
• Providence Medical Institute

  dba Providence Little Company of Mary Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1235182569

  Dermatology

  NPD
• Providence Medical Institute

  dba Providence Little Company of Mary Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1760425862

  Dermatology

  NPD

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

{
    "created_epoch": "1365120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1801139068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 HIGHLAND AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537920001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7373 WEST LN STE 355",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952103377",
            "telephone_number": "209-476-2166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "LYDIA",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-05",
        "last_updated": "2021-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WI",
            "license": "64429",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A150150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4601 Dale Rd",
            "city": "Modesto",
            "state": "CA",
            "country_code": "US",
            "postal_code": "953569718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Han Kim, M.D.
• Hyung Guen Kim, DDS MSD
• James Kim, MD
• Kaela Hanur Kim, PHARMD
• Leah Sungmi Kim
• Stevens Young-Jun Kim, MD
• Sunphil Kim, MD
• Susan Kim, DMD, MSD
• Yoon H. Kim, DO
• Kimberly Burton, Inc.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.