Active NPI
Donald D Kim, MD
- Pediatric Orthopaedic Surgery Physician
- Riverside, CA
National Provider Identifier
1801891734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Orthopaedic Surgery Physician
- License
- G58622
- Practice address
- 4354 Latham St Ste 100
Riverside, CA 92501-1777 - Phone
- (951) 683-0650
- Fax
- (951) 774-4612
- NPI assigned
- Jun 16, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | G58622 | CA | |
| Orthopaedic Surgery of the Spine Physician | 207XS0117X | G58622 | CA | |
| Pediatric Orthopaedic Surgery Physician | 207XP3100X | G58622 | CA | Primary |
Addresses
Primary practice location
4354 Latham St Ste 100
Riverside, CA 92501-1777
Mailing address
4354 Latham St Ste 100
Riverside, CA 92501-1777
Phone (951) 683-0650
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080623000474 | CA | Practitioner - Orthopedic Surgery | 9032280847 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G58622 | CA | MD | Orthopaedic Surgery of the Spine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581292800000",
"number": "1801891734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4354 LATHAM ST STE 100",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925011777",
"telephone_number": "951-683-0650",
"fax_number": "951-774-4612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4354 LATHAM ST STE 100",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925011777",
"telephone_number": "951-683-0650",
"fax_number": "951-774-4612"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "DONALD",
"middle_name": "D",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-16",
"last_updated": "2020-02-10",
"certification_date": "2020-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "CA",
"license": "G58622",
"primary": false
},
{
"code": "207XS0117X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
"state": "CA",
"license": "G58622",
"primary": false
},
{
"code": "207XP3100X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
"state": "CA",
"license": "G58622",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2020; 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.