JOSEPH KIM MD
NPI 1174105050
Student in an Organized Health Care Education/Training Program in Fontana, CA

Q: What is Joseph Kim's NPI number?

The NPI number for Joseph Kim is 1174105050. It was assigned to this individual provider in the NPPES registry on April 21, 2021.

Q: What is Joseph Kim's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Joseph Kim was last updated on December 6, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.

Active since April 21, 2021PECOS EnrolledAccepts Medicare Assignment

17234 VALLEY BLVD, BUILDING A, FONTANA, CA 92335(909) 427-2608 Get Directions Write a Review

NPPES record last updated: December 6, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 6, 2021, Apr 21, 2021 (2 updates tracked since 2021).

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About Joseph Kim Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JOSEPH KIM MD (NPI 1174105050) is an individual student in an organized health care education/training program in Fontana, California and active in the NPI registry since April 2021. He is enrolled in Medicare PECOS and is a graduate of University Of California, Irvine, California College Of Medicine (2025).

NPPES Registry Identity

NPI1174105050

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameJOSEPH KIMCredential: MD

Location Address17234 VALLEY BLVD, BUILDING AFontana, CA 92335

Mailing Address17234 Valley Blvd, Building AFontana, CA 92335 · (909) 569-4387

Phone(909) 427-2608

Sole ProprietorNo

Medical School CMSUniversity Of California, Irvine, California College Of MedicineGraduated 2025

Enumeration DateApril 21, 2021

Last NPPES UpdateDecember 6, 20212 updates tracked since enumeration

NPPES CertifiedMarch 27, 2021

✔ NPI 1174105050 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

17234 VALLEY BLVD, BUILDING A, Fontana, CA 92335

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Joseph Kim Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8426445602

PECOS Enrollment IDI20251014003443

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SKYLAR RAINS MD

Student in an Organized Health Care Education/Training Program