DR. JEONG HWAN JAKE KIM MD
NPI 1255919197
Student in an Organized Health Care Education/Training Program in Thousand Oaks, CA

Q: What is Jeong Hwan Kim's NPI number?

The NPI number for Jeong Hwan Kim is 1255919197. It was assigned to this individual provider in the NPPES registry on March 31, 2021.

Q: What is Jeong Hwan 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 Jeong Hwan Kim was last updated on March 31, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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 March 31, 2021PECOS Enrolled

215 W JANSS RD, THOUSAND OAKS, CA 91360(805) 497-2727 Get Directions Write a Review

NPPES record last updated: March 31, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Dr. Jeong Hwan Jake Kim Md NPPES

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

DR. JEONG HWAN JAKE KIM MD (NPI 1255919197) is an individual student in an organized health care education/training program in Thousand Oaks, California and active in the NPI registry since March 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1255919197

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameDR. JEONG HWAN JAKE KIMCredential: MD

Location Address215 W JANSS RDThousand Oaks, CA 91360-1847

Mailing Address2124 Lyans DrLa Canada Flintridge, CA 91011-1539 · (661) 964-8344

Phone(805) 497-2727

Sole ProprietorNo

Enumeration DateMarch 31, 2021

NPPES CertifiedMarch 31, 2021

✔ NPI 1255919197 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.

215 W JANSS RD, Thousand Oaks, CA 91360

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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 (PECOS)

Dr. Jeong Hwan Jake Kim Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 20

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

LOS ROBLES RADIOLOGIC ASSOCIATES

Radiology (Diagnostic Radiology)