Michelle Lara Kim, O.T.R./L

Primary specialty

SpecialistTaxonomy code 174400000X

License

OT 2282 Issued in CA

Practice address

9161 Sierra Ave
Suite 111
Fontana, CA 92335-4729

Phone

(909) 427-4073

NPI assigned

Apr 27, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1240790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1851535413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26430 MARGARITA LN",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923546741",
            "telephone_number": "909-210-3892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9161 SIERRA AVE",
            "address_2": "SUITE 111",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923354729",
            "telephone_number": "909-427-4073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MICHELLE",
        "middle_name": "LARA",
        "name_prefix": "Mrs.",
        "credential": "O.T.R./L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-27",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "OT 2282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Joel Chul Ju Kim, D.D.S.
• Jonathan Kim, D.D.S.
• Joseph Kim, MD
• Joseph Bo-Young Kim, M.D.
• Kyung-Il John Kim
• Natalia Kim
• Paul Kim, PHARM.D.
• Paul B. Kim, MD
• Sam K. Kim, MD
• Sang Woo Kim, L.AC.

• Specialist in Fontana, CA
• Providers in Fontana, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.