Jin Man Kim Family MD Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A61463 Issued in CA

Legal business name

JIN MAN KIM FAMILY MD INC

Practice address

8237 Rochester Ave
#130
Rancho Cucamonga, CA 91730-6780

Phone

(909) 948-7590

Fax

(909) 948-7290

NPI assigned

Apr 3, 2007

Last updated

Jul 13, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jin Man Kim, M.D.NPI 1558371401

Title

Family Practice

Phone

(909) 948-7590

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jin Man Kim, M.D.

  • Family Medicine Physician
  • Rancho Cucamonga, CA
  • NPI 1558371401
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436745600000",
    "number": "1851412894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8237 ROCHESTER AVE",
            "address_2": "#130",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917300716",
            "telephone_number": "909-948-7590",
            "fax_number": "909-948-7290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8237 ROCHESTER AVE",
            "address_2": "#130",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917306780",
            "telephone_number": "909-948-7590",
            "fax_number": "909-948-7290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIN MAN KIM FAMILY MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2015-07-13",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JIN",
        "authorized_official_middle_name": "MAN",
        "authorized_official_title_or_position": "FAMILY PRACTICE",
        "authorized_official_telephone_number": "909-948-7590",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A61463",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LIC #",
            "identifier": "A61463",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.