Individual provider Active NPI

Catherine Chong-Ae Kim, MD

  • Obstetrics & Gynecology Physician
  • Simi Valley, CA
National Provider Identifier
1972596120
Registry record updated Jun 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
A55929 Issued in CA
Practice address
1147 Red Tail Way
Simi Valley, CA 93065-7232
Phone
(805) 527-8055
Fax
(805) 520-8849
NPI assigned
Aug 23, 2005
Last updated
Jun 27, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X A55929 CA Primary

Addresses

Primary practice location

1147 Red Tail Way
Simi Valley, CA 93065-7232

Mailing address

1147 Red Tail Way
Simi Valley, CA 93065-7232
Phone (805) 527-8055

Other identifiers 1

IdentifierTypeStateIssuer
00A559290MedicaidCA

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101122000900 CA Practitioner - Obstetrics/Gynecology 7911193529 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of California, Geffen School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1147 Red Tail Way
Simi Valley, CA 93065-7232
Phone (805) 527-8055

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
55929CAMDGeneral Practice Dentistry
A55929CAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Obhg California, P.C. Obstetrics & Gynecology CurrentSince Feb 1, 2025 Accepting new patients
Simi Obstetrics & Gynecology Medical Group a Medical Corp. Obstetrics & Gynecology CurrentSince Oct 17, 2000 Accepting new patients
Los Robles Regional Medical Center Past Accepting new patients
Simi Valley Hospital and Health Care Services Past Accepting new patients
Samir E. Hage, D.O., Inc. Obstetrics & Gynecology Past Accepting new patients

Locations

1147 Red Tail Way
Simi Valley, CA 93065
Phone (805) 527-8055

215 W Janss Rd
Thousand Oaks, CA 91360
Phone (805) 379-5435

Interoperability endpoints

  • Direct secure messaging: catherinekim@prmg.allscriptsdirect.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340755200000",
    "number": "1972596120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1147 RED TAIL WAY",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930657232",
            "telephone_number": "805-527-8055",
            "fax_number": "805-520-8849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1147 RED TAIL WAY",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930657232",
            "telephone_number": "805-527-8055",
            "fax_number": "805-520-8849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CATHERINE",
        "middle_name": "CHONG-AE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-23",
        "last_updated": "2012-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A55929",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A559290",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Simi Valley, CA

Sources for this page

Verify at the official NPI Registry.