Active NPI
Sean H Kim, D.C.
- Chiropractor
- San Diego, CA
National Provider Identifier
1922311489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 31728
- Practice address
- 2535 Kettner Blvd Ste 2A3
San Diego, CA 92101-1253 - Phone
- (619) 501-7873
- NPI assigned
- Jul 26, 2010
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 31728 | CA | Primary |
Addresses
Primary practice location
2535 Kettner Blvd Ste 2A3
San Diego, CA 92101-1253
Mailing address
2535 Kettner Blvd Ste 2A3
San Diego, CA 92101-1253
Phone (619) 501-7873
Other practice location 1
3503 4th Ave
San Diego, CA 92103-4912
Phone (619) 501-7873
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31728 | CA | MD | Critical Care Registered Respiratory Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cannon & Rutkoski Chiropractic | Chiropractor | Past | Accepting new patients |
| Nguyentu Chiropractic, Inc. | Chiropractor | Past | Accepting new patients |
| Cannon & Rutkoski Chiropractic, a Professional Corporation | Chiropractor | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Chiropractor
- San Diego, CA
- NPI 1417222506
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590451200000",
"number": "1922311489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2535 KETTNER BLVD STE 2A3",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921011253",
"telephone_number": "619-501-7873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2535 KETTNER BLVD STE 2A3",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921011253",
"telephone_number": "619-501-7873"
}
],
"practiceLocations": [
{
"address_1": "3503 4th Ave",
"address_purpose": "LOCATION",
"city": "San Diego",
"state": "CA",
"postal_code": "921034912",
"country_code": "US",
"telephone_number": "619-501-7873",
"fax_number": "619-501-7883",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIM",
"first_name": "SEAN",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-07-26",
"last_updated": "2020-05-26",
"certification_date": "2020-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "31728",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.