Individual provider Active NPI

Hyo Im Kim, FNP

  • Family Nurse Practitioner
  • Granada Hills, CA
National Provider Identifier
1861384182
Registry record updated Jul 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95035327 Issued in CA
Practice address
16256 Hiawatha St
Granada Hills, CA 91344-6828
Phone
(818) 271-6035
NPI assigned
Jul 21, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95035327 CA Primary

Addresses

Primary practice location

16256 Hiawatha St
Granada Hills, CA 91344-6828

Mailing address

16256 Hiawatha St
Granada Hills, CA 91344-6828
Phone (818) 271-6035

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251212003717 CA Practitioner - Nurse Practitioner 3375037617 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

16256 Hiawatha St
Granada Hills, CA 91344-6828

510 Thornall St
Suite 100
Edison, NJ 08837-2204

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95035327CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Agoura Hills Urgentocare PC CurrentSince Oct 4, 2025 Accepting new patients

Locations

5825 Kanan Rd
Agoura Hills, CA 91301
Phone (424) 355-1963

5825 Kanan Rd
Ste B
Agoura Hills, CA 91301
Phone (424) 355-9163

475 E Avenida de los Arboles
Ste B
Thousand Oaks, CA 91360
Phone (818) 483-0885

Organizations & group practices 1

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": "1753056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753056000000",
    "number": "1861384182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16256 HIAWATHA ST",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913446828",
            "telephone_number": "818-271-6035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16256 HIAWATHA ST",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913446828",
            "telephone_number": "818-271-6035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "HYO IM",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-07-21",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95035327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Granada Hills, CA

Sources for this page

Verify at the official NPI Registry.