Active NPI
Lino Kim, PA-C
- Physician Assistant
- Los Angeles, CA
National Provider Identifier
1902169121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 2051 Marengo St
Lac-Usc Medical Center, Dem, Ipt, RM C1A108
Los Angeles, CA 90033-1352 - Phone
- (818) 568-4860
- NPI assigned
- Jun 21, 2012
- Sex
- Male
- Sole proprietor
- No
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 | Primary |
Addresses
Primary practice location
2051 Marengo St
Lac-Usc Medical Center, Dem, Ipt, RM C1A108
Los Angeles, CA 90033-1352
Mailing address
2051 Marengo St
Lac-Usc Medical Center, Dem, Ipt, RM C1A108
Los Angeles, CA 90033-1352
Phone (818) 568-4860
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
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130930000295 | CA | Order and Referring Only - Physician Assistant | 0446484703 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414540800000",
"number": "1902169121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2051 MARENGO ST",
"address_2": "LAC-USC MEDICAL CENTER, DEM, IPT, RM C1A108",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900331352",
"telephone_number": "818-568-4860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2051 MARENGO ST",
"address_2": "LAC-USC MEDICAL CENTER, DEM, IPT, RM C1A108",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900331352",
"telephone_number": "818-568-4860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "LINO",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-21",
"last_updated": "2014-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"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 Oct 29, 2014; 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.