Individual provider Active NPI

James Sunkook Kim, MD

  • Pediatrics Physician
  • Los Angeles, CA
National Provider Identifier
1821399551
Registry record updated Nov 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A111651 Issued in CA
Practice address
4650 W Sunset Blvd # 68
Los Angeles, CA 90027-6062
Phone
(323) 361-2122
NPI assigned
Nov 11, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A111651 CA Primary

Addresses

Primary practice location

4650 W Sunset Blvd # 68
Los Angeles, CA 90027-6062

Mailing address

4650 W Sunset Blvd # 68
Los Angeles, CA 90027-6062
Phone (323) 361-2122

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jkim1373710@oc.providencedirect.org

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
I20110809000408 CA Practitioner - Pediatric Medicine 8022287044 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A111651CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Apr 19, 2017 Accepting new patients
Providence Medical Foundation CurrentSince Apr 19, 2017 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Children'S Hospital Los Angeles Past Accepting new patients
St Joseph Hospital of Orange Past Accepting new patients
Children'S Hospital Los Angeles Medical Group, Inc. Pediatrics Past Accepting new patients
Providence Medical Foundation Past Accepting new patients

Locations

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

2212 E 4th St
Ste 201
Santa Ana, CA 92705
Phone (714) 288-3230

2212 E 4th St
Santa Ana, CA 92705
Phone (714) 288-3230

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 7

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

NPI Registry JSON

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

{
    "created_epoch": "1289433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636070400000",
    "number": "1821399551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4650 W SUNSET BLVD # 68",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276062",
            "telephone_number": "323-361-2122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 W SUNSET BLVD # 68",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276062",
            "telephone_number": "323-361-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JAMES",
        "middle_name": "SUNKOOK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-11-11",
        "last_updated": "2021-11-05",
        "certification_date": "2021-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A111651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jkim1373710@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "2212 E 4th St Ste 201",
            "city": "Santa Ana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "927053872",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.