Active NPI
Bryan Kim
- Student in an Organized Health Care Education/Training Program
- Santa Clara, CA
National Provider Identifier
1811699564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 700 Lawrence Expy
Santa Clara, CA 95051-5173 - Phone
- (408) 851-1000
- NPI assigned
- Mar 20, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
700 Lawrence Expy
Santa Clara, CA 95051-5173
Mailing address
3333 Green Bay Rd
North Chicago, IL 60064-3037
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 |
|---|---|---|---|---|
| I20250228003128 | CA | Order and Referring Only - Internal Medicine | 1850812256 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710979200000",
"number": "1811699564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3333 GREEN BAY RD",
"city": "NORTH CHICAGO",
"state": "IL",
"postal_code": "600643037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 LAWRENCE EXPY",
"city": "SANTA CLARA",
"state": "CA",
"postal_code": "950515173",
"telephone_number": "408-851-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "BRYAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-03-20",
"last_updated": "2024-03-21",
"certification_date": "2024-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Clara, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2024; 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.