Garry Kijung Kim, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A67703 Issued in CA

Practice address

50 Bellefontaine Street
Suite 305
Pasadena, CA 91105

Phone

(626) 795-0415

NPI assigned

Sep 13, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 10, 2020 through Mar 10, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Lakeside Medical Associates, a Medical Group, Inc.

  • Hospitalist Physician
  • Glendale, CA
  • NPI 1932129434

  Internal Medicine

  NPD (past)
• Lakeside Medical Organization, a Medical Group Inc.

  • Internal Medicine Physician
  • West Hills, CA
  • NPI 1831426642
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1932204195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 BELLEFONTAINE STREET",
            "address_2": "SUITE 305",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "91105",
            "telephone_number": "626-795-0415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 BELLEFONTAINE STREET",
            "address_2": "SUITE 305",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "91105",
            "telephone_number": "626-795-0415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "GARRY",
        "middle_name": "KIJUNG",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A67703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cindy Kim, LCSW
• Cloe Taehee Kim, LCSW, MSW
• Doyoun Kim, NP
• Emill C Kim, O.M.D. L.AC
• Esther Kim, MD
• Grace Joy Kim, PHARM.D.
• Grace Sun Kim
• Harry Hanwool Kim
• Hayoung Kim
• Hoejeong Kim

• Internal Medicine Physician in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.