Individual provider Active NPI

Martin Kikulwe Kimera

  • Registered Nurse
  • Orange, CA
National Provider Identifier
1851919617
Registry record updated Jul 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
585036 Issued in CA
Practice address
1700 Marine Dr
Orange, CA 92867-4058
Phone
(714) 485-6140
NPI assigned
Jul 8, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 10, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 585036 CA Primary

Addresses

Primary practice location

1700 Marine Dr
Orange, CA 92867-4058

Mailing address

17853 Santiago Blvd
Suite 107-151
Villa Park, CA 92861-4199
Phone (714) 485-6140

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

State licenses

LicenseStateTypeSpecialty
585036CAMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1594166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752105600000",
    "number": "1851919617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17853 SANTIAGO BLVD",
            "address_2": "SUITE 107-151",
            "city": "VILLA PARK",
            "state": "CA",
            "postal_code": "928614199",
            "telephone_number": "714-485-6140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 MARINE DR",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928674058",
            "telephone_number": "714-485-6140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMERA",
        "first_name": "MARTIN",
        "middle_name": "KIKULWE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-08",
        "last_updated": "2025-07-10",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "585036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2025; 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.