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KIM YOUNGRAE MEDICAL, INC
NPI 1275242083
Internal Medicine - Rheumatology in Buena Park, CA

Active since November 21, 2022CLIA 05D2285863 · Waiver
5730 BEACH BLVD, #200, BUENA PARK, CA 90621(714) 588-4024 Get Directions Write a Review

NPPES record last updated: November 17, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Nov 17, 2023, Nov 21, 2022 (2 updates tracked since 2022).

About Kim Youngrae Medical, Inc NPPES

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

KIM YOUNGRAE MEDICAL, INC (NPI 1275242083) is a healthcare organization registered as a rheumatology in Buena Park, California and active in the NPI registry since November 2022. The organization holds a CLIA Waiver certificate valid through July 18, 2027 and lists Nicholas Youngrae Kim, President, as its authorized official.

NPPES Registry Identity

NPI1275242083
Entity TypeOrganization
Primary Taxonomy207RR0500X
Legal Business NameKIM YOUNGRAE MEDICAL, INC
Location Address5730 BEACH BLVD, #200Buena Park, CA 90621-4305
Mailing Address5730 Beach Blvd, #200Buena Park, CA 90621-4305 · (714) 588-4024
Phone(714) 588-4024
Organization SubpartNo
Authorized OfficialNicholas Youngrae KimPresident · (714) 588-4037
Enumeration DateNovember 21, 2022
Last NPPES UpdateNovember 17, 20232 updates tracked since enumeration
NPPES CertifiedNovember 17, 2023
✔ NPI 1275242083 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · RheumatologyAllopathic & Osteopathic Physicians
Taxonomy Code207RR0500X
Definition
An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and collagen diseases.
5730 BEACH BLVD, Buena Park, CA 90621
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kim Youngrae Medical, Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Kim Youngrae Medical, Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Nicholas Kim, M.D.
Internal Medicine
NPI 1235227760
3010 W ORANGE AVE #409
Anaheim, CA 92804
(714) 484-3781
✔ PECOS✔ Accepts Medicare3.6 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2285863

Kim Youngrae Medical, Inc · Buena Park, CA
Active · expires Jul 18, 2027
CLIA Number05D2285863
Laboratory TypePhysician Office
Certificate Effective DateJuly 19, 2025
Certificate Expiration DateJuly 18, 2027
Laboratory DirectorNicholas Y. Kim
Laboratory Phone(714) 594-6962
Laboratory LocationKim Youngrae Medical, Inc5730 Beach Blvd Suite 200, Buena Park, CA 90621
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

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 Kim Youngrae Medical, Inc's NPI number?

The NPI number for Kim Youngrae Medical, Inc is 1275242083. It was assigned to this organization in the NPPES registry on November 21, 2022.

Where is Kim Youngrae Medical, Inc located?

Kim Youngrae Medical, Inc is located at 5730 Beach Blvd #200, Buena Park, CA 90621. The listed phone number is (714) 588-4024.

What is Kim Youngrae Medical, Inc's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Rheumatology, with taxonomy code 207RR0500X.

Is Kim Youngrae Medical, Inc enrolled in Medicare?

Yes. Kim Youngrae Medical, Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Kim Youngrae Medical, Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Kim Youngrae Medical, Inc. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Kim Youngrae Medical, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2285863) is associated with this NPI, valid through July 18, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Kim Youngrae Medical, Inc was last updated on November 17, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.