KYOUNG JIN KIM AGNP-BC
NPI 1609392919
Nurse Practitioner - Primary Care in Gardena, CA
About Kyoung Jin Kim Agnp-bc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KYOUNG JIN KIM AGNP-BC (NPI 1609392919) is an individual primary care provider in Gardena, California, licensed in California (NP95006053) and active in the NPI registry since August 2017. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses 4
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kyoung Jin Kim Agnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kyoung Jin Kim reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Gardena, CA 90249
- Reassigned Medicare billing, California enrollment
- 3 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 90249 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Kyoung Jin Kim's NPI number?
The NPI number for Kyoung Jin Kim is 1609392919. It was assigned to this individual provider in the NPPES registry on August 17, 2017.
Where is Kyoung Jin Kim located?
Kyoung Jin Kim practices at 15435 S Western Ave Ste 201, Gardena, CA 90249. The listed phone number is (213) 215-7323.
What is Kyoung Jin Kim's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.
Is Kyoung Jin Kim enrolled in Medicare?
Yes. Kyoung Jin Kim is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kyoung Jin Kim's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kyoung Jin Kim reassigns Medicare benefits to Suk Medical Clinic Inc (Gardena, 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 Kyoung Jin 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 Kyoung Jin Kim was last updated on August 17, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.
# Kyoung Jin Kim, AGNP-BC · NPI 1609392919
Primary Care physician in Gardena, California. Individual provider, active in the CMS NPPES registry since August 17, 2017.
## Identity
- **NPI:** 1609392919 (Entity type: Individual)
- **Enumerated:** August 17, 2017
- **Primary specialty:** Nurse Practitioner - Primary Care · taxonomy 363LP2300X
- **State license:** NP95006053 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 15435 S WESTERN AVE STE 201, Gardena, CA 90249-4324
- **Phone:** (213) 215-7323
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Suk Medical Clinic Inc (NPI 1720581382, Gardena, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 17, 2017
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Source: [NPI Profile](https://npiprofile.com/npi/1609392919) · Data from the CMS NPPES public registry.