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STAECY Y KIM MD
NPI 1578060976
Pediatrics - Neonatal-Perinatal Medicine in Tarzana, CA

Active since April 11, 2018PECOS EnrolledAccepts Medicare Assignment
18321 CLARK ST, TARZANA, CA 91356(818) 708-5570(818) 708-5471 Get Directions Write a Review

NPPES record last updated: December 19, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 19, 2024, Aug 13, 2024, Jan 9, 2023 and 1 more (4 updates tracked since 2018).

About Staecy Y Kim Md NPPES

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

STAECY Y KIM MD (NPI 1578060976) is an individual neonatal-perinatal medicine provider in Tarzana, California, licensed in California (A173674) and active in the NPI registry since April 2018. She is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of University Of Cincinnati College Of Medicine (2014).

NPPES Registry Identity

NPI1578060976
Entity TypeIndividualFemale
Primary Taxonomy2080N0001X
Provider Legal NameSTAECY Y KIMCredential: MD
Location Address18321 CLARK STTarzana, CA 91356-3501
Mailing Address4140 W 190th StTorrance, CA 90504-5513
Phone(818) 708-5570
Fax(818) 708-5471
Sole ProprietorNo
Medical School CMSUniversity Of Cincinnati College Of MedicineGraduated 2014
Enumeration DateApril 11, 2018
Last NPPES UpdateDecember 19, 20244 updates tracked since enumeration
NPPES CertifiedDecember 19, 2024
✔ NPI 1578060976 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Neonatal-Perinatal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080N0001X
License✔ Licensed in CA · A173674
Definition
A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies.
18321 CLARK ST, Tarzana, CA 91356
Open in Google Maps ↗

Secondary Practice Locations 2

Location 14650 W Sunset BlvdLos Angeles, CA 90027-6062 · Phone (888) 631-2452
Location 28700 Beverly BlvdWest Hollywood, CA 90048-1804 · Phone (310) 423-4451 · Fax (310) 423-2114

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

Staecy Y 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 ID7416325360
PECOS Enrollment IDI20221125000166
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.

DR. JONATHAN ANDREW PRINCE M.D.
Emergency Medicine
18321 CLARK ST
TARZANA, CA 91356
Los Angeles County (818) 708-5170
ART ONCOLOGY INC
Radiology (Diagnostic Radiology)
18321 CLARK ST
TARZANA, CA 91356
Los Angeles County (215) 313-0024
DR. NEIL ERIC CANBY M.D.
Emergency Medicine
18321 CLARK ST
TARZANA, CA 91356
Los Angeles County (818) 708-5170
KELLY ANN ARCHER KAMINSKI OTR/L
Occupational Therapist
18321 CLARK ST
TARZANA, CA 91356
Los Angeles County (818) 881-0800
DR. FREDERICK THEODORE DENNIS M.D.
Emergency Medicine
18321 CLARK ST
TARZANA, CA 91356
Los Angeles County (818) 708-5170
KIMBERLY DANG PHAM
Pharmacist
18321 CLARK ST
TARZANA, CA 91356
Los Angeles County (818) 881-0800
CAROL V GREENE NNP
Nurse Practitioner (Neonatal)
18321 CLARK ST
TARZANA, CA 91356
Los Angeles County (818) 708-5242
CARMEN BOTERO, MD
Pediatrics (Pediatric Critical Care Medicine)
18321 CLARK ST
TARZANA, CA 91356
Los Angeles County (208) 676-9080

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 Staecy Kim's NPI number?

The NPI number for Staecy Kim is 1578060976. It was assigned to this individual provider in the NPPES registry on April 11, 2018.

Where is Staecy Kim located?

Staecy Kim practices at 18321 Clark St, Tarzana, CA 91356. The listed phone number is (818) 708-5570.

What is Staecy Kim's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Neonatal-Perinatal Medicine, with taxonomy code 2080N0001X.

Is Staecy Kim enrolled in Medicare?

Yes. Staecy Kim is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Staecy Kim was last updated on December 19, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months 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.