Active NPI
Mi Song Kim, MD
- Emergency Medicine Physician
- Riverside, CA
National Provider Identifier
1972182640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- A193015
- Practice address
- 4445 Magnolia Ave
Riverside, CA 92501-4135 - Phone
- (951) 788-3000
- NPI assigned
- Apr 7, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Emergency Medicine Physician | 207P00000X | A193015 | CA | Primary |
Addresses
Primary practice location
4445 Magnolia Ave
Riverside, CA 92501-4135
Mailing address
2317 W Broadway Unit 98
Anaheim, CA 92804-2593
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240717002953 | CA | Practitioner - Emergency Medicine | 4385189034 | Reassigns benefits to 3 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Emergency Medicine
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- HMH Emergency Medical Group, Inc.St Jude Emergency Medical Group Inc
Practice addresses (Care Compare)
100 W California Blvd
Pasadena, CA 91105-3010
Phone 6264470296142
101 E Valencia Mesa Dr
Fullerton, CA 92835-3809
Phone (714) 871-3280
Hospital & facility affiliations
- Providence St. Jude Medical Center
- Huntington Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A193015 | CA | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| HMH Emergency Medical Group, Inc. | Emergency Medicine | Current | Accepting new patients |
| St Jude Emergency Medical Group Inc | Emergency Medicine | Current | Accepting new patients |
| Huntington Memorial Hospital | Past | Accepting new patients |
Locations
101 E Valencia Mesa Dr
Fullerton, CA 92835
Phone (714) 446-7505
100 W California Blvd
Pasadena, CA 91105
Phone (626) 397-3445
Interoperability endpoints
- mkim505026@direct.cshs.org
Organizations & group practices 4
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.
-
- Emergency Medicine Physician
- Pasadena, CA
- NPI 1659383024
CA, Emergency Medicine
-
- Emergency Medicine Physician
- Fullerton, CA
- NPI 1720190804
CA, Emergency Medicine
-
- General Acute Care Hospital
- Pasadena, CA
- NPI 1467672667
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727049600000",
"number": "1972182640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2317 W BROADWAY UNIT 98",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928042593"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4445 MAGNOLIA AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925014135",
"telephone_number": "951-788-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MI SONG",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-07",
"last_updated": "2024-09-23",
"certification_date": "2024-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "CA",
"license": "A193015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.