Individual provider Active NPI

Donald D Kim, MD

  • Pediatric Orthopaedic Surgery Physician
  • Riverside, CA
National Provider Identifier
1801891734
Registry record updated Feb 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Orthopaedic Surgery PhysicianTaxonomy code 207XP3100X
License
G58622 Issued in CA
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

Updated by the provider on Feb 10, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080623000474 CA Practitioner - Orthopedic Surgery 9032280847

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G58622CAMDOrthopaedic 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

Verify at the official NPI Registry.