Active NPI
Jennifer Young Kim, MD
- Pediatrics Physician
- West Covina, CA
National Provider Identifier
1861132250
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A202453
- Practice address
- 1300 S Sunset Ave
West Covina, CA 91790-3342 - Phone
- (626) 960-6999
- Fax
- (626) 960-5246
- NPI assigned
- Apr 1, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A202453 | CA | Primary |
Addresses
Primary practice location
1300 S Sunset Ave
West Covina, CA 91790-3342
Mailing address
1300 S Sunset Ave
West Covina, CA 91790-3342
Phone (626) 960-6999
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 |
|---|---|---|---|---|
| I20250618003360 | CA | Order and Referring Only - Pediatric Medicine | 4981115649 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A202453 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751932800000",
"number": "1861132250",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 S SUNSET AVE",
"city": "WEST COVINA",
"state": "CA",
"postal_code": "917903342",
"telephone_number": "626-960-6999",
"fax_number": "626-960-5246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 S SUNSET AVE",
"city": "WEST COVINA",
"state": "CA",
"postal_code": "917903342",
"telephone_number": "626-960-6999",
"fax_number": "626-960-5246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JENNIFER",
"middle_name": "YOUNG",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-04-01",
"last_updated": "2025-07-08",
"certification_date": "2025-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pediatrics",
"state": "CA",
"license": "A202453",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2025; 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.