Excel Spine Center a California Medical Corporation

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

Legal business name

EXCEL SPINE CENTER A CALIFORNIA MEDICAL CORPORATION

Practice address

6719 Alvarado Rd Ste 304
San Diego, CA 92120-5265

Phone

(619) 344-6918

NPI assigned

Sep 23, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Choll Wan Kim, MD, PHD

Title

Owner

Phone

(619) 344-6918

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alexandra Marie-Mero McCann

  • Physician Assistant
  • San Diego, CA
  • NPI 1306518758
  Medicare reassignment Care Compare group
• Danielle Frances Morgen, PA-C

  • Physician Assistant
  • San Diego, CA
  • NPI 1205653532
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1600819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670803200000",
    "number": "1962018044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6719 ALVARADO RD STE 304",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921205265",
            "telephone_number": "619-344-6918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6719 ALVARADO RD STE 304",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921205265",
            "telephone_number": "619-344-6918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEL SPINE CENTER A CALIFORNIA MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-23",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-12",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "CHOLL",
        "authorized_official_middle_name": "WAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-344-6918",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Excel Speech Therapy Center
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• Desirae Rachelle Exendine, DNP, APRN, NNP-BC
• Ingrid Wolfer Exerjian, MA, CCC, SLP
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• Orthopaedic Surgery of the Spine Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Orthopaedic Surgery of the Spine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.