Active NPI
Bomi Kim, PA
- Physician Assistant
- Los Angeles, CA
National Provider Identifier
1871158527
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA57376
- Practice address
- 1234 Wilshire Blvd Apt 335
Los Angeles, CA 90017-1979 - Phone
- (213) 222-7255
- NPI assigned
- May 8, 2019
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA57376 | CA | Primary |
Addresses
Primary practice location
1234 Wilshire Blvd Apt 335
Los Angeles, CA 90017-1979
Mailing address
1234 Wilshire Blvd Apt 335
Los Angeles, CA 90017-1979
Phone (213) 222-7255
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57376 | CA | MD | Pharmacist |
| PA57376 | CA | MD | Physician Assistant |
Organizations & group practices 2
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.
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- Burbank, CA
- NPI 1124693924
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745193600000",
"number": "1871158527",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1234 WILSHIRE BLVD APT 335",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900171979",
"telephone_number": "213-222-7255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1234 WILSHIRE BLVD APT 335",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900171979",
"telephone_number": "213-222-7255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "BOMI",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-08",
"last_updated": "2025-04-21",
"certification_date": "2025-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA57376",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 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.