Active NPI
Roy Kyung-Won Kim, M.D.
- Family Medicine Physician
- Rancho Cucamonga, CA
National Provider Identifier
1811014392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- A90697
- Practice address
- 10750 4TH St Ste 150
Rancho Cucamonga, CA 91730-0979 - Phone
- (916) 956-4849
- NPI assigned
- Mar 22, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A90697 | CA | Primary |
Addresses
Primary practice location
10750 4TH St Ste 150
Rancho Cucamonga, CA 91730-0979
Mailing address
10750 4TH St Ste 150
Rancho Cucamonga, CA 91730-0979
Phone (916) 956-4849
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A90697 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782432000000",
"number": "1811014392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10750 4TH ST STE 150",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917300979",
"telephone_number": "916-956-4849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10750 4TH ST STE 150",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917300979",
"telephone_number": "916-956-4849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "ROY",
"middle_name": "KYUNG-WON",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-22",
"last_updated": "2026-06-26",
"certification_date": "2026-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "A90697",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cucamonga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.