KELLEY KIM
NPI 1104102250
Social Worker in Buena Park, CA
About Kelley Kim NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLEY KIM (NPI 1104102250) is an individual social worker in Buena Park, California and active in the NPI registry since November 2011. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kelley Kim is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kelley Kim reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Fullerton, CA 92833
- Reassigned Medicare billing, California enrollment
- Also billed through NPI 1396287082 (California)
- 13,921 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kelley Kim's NPI number?
The NPI number for Kelley Kim is 1104102250. It was assigned to this individual provider in the NPPES registry on November 2, 2011.
Where is Kelley Kim located?
Kelley Kim practices at 7212 Orangethorpe Ave Ste 9, Buena Park, CA 90621. The listed phone number is (714) 449-1125.
What is Kelley Kim's specialty?
The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.
Is Kelley Kim enrolled in Medicare?
Yes. Kelley Kim is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kelley Kim's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelley Kim reassigns Medicare benefits to Southern California Permanente Medical Group (Fullerton, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelley Kim's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Kelley Kim was last updated on November 2, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kelley Kim · NPI 1104102250
Social Worker provider in Buena Park, California. Individual provider, active in the CMS NPPES registry since November 2, 2011.
## Identity
- **NPI:** 1104102250 (Entity type: Individual)
- **Enumerated:** November 2, 2011
- **Primary specialty:** Social Worker · taxonomy 104100000X
- **Sole proprietor:** No
## Practice location
- **Address:** 7212 ORANGETHORPE AVE STE 9, Buena Park, CA 90621-4668
- **Phone:** (714) 449-1125
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Southern California Permanente Medical Group (NPI 1336556059, Fullerton, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 2, 2011
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Source: [NPI Profile](https://npiprofile.com/npi/1104102250) · Data from the CMS NPPES public registry.