Active NPI
Il Nam Kim, L.AC.
- Contractor
- Riverside, CA
National Provider Identifier
1982826525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- AC 11248
- Practice address
- 1485 Spruce St
Suite P
Riverside, CA 92507-2445 - Phone
- (951) 682-8167
- NPI assigned
- May 3, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Contractor | 171W00000X | AC 11248 | CA | Primary |
Addresses
Primary practice location
1485 Spruce St
Suite P
Riverside, CA 92507-2445
Mailing address
23978 Boulder Oaks Dr
Corona, CA 92883-4151
Phone (714) 595-7377
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC 11248 | CA | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1982826525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23978 BOULDER OAKS DR",
"city": "CORONA",
"state": "CA",
"postal_code": "928834151",
"telephone_number": "714-595-7377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1485 SPRUCE ST",
"address_2": "SUITE P",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925072445",
"telephone_number": "951-682-8167"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "IL",
"middle_name": "NAM",
"credential": "L.AC.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "CA",
"license": "AC 11248",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.