1. Home
  2. Directory
  3. California
  4. Fountain Valley
  5. Pediatrics
  6. NPI Profile

KENNETH KIM M.D
NPI 1922002468
Pediatrics - Pediatric Critical Care Medicine in Fountain Valley, CA

Active since June 13, 2005PECOS Enrolled
17100 EUCLID ST., PICU, FOUNTAIN VALLEY, CA 92708(714) 966-7253(714) 966-3354 Get Directions Write a Review

NPPES record last updated: August 19, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Kenneth Kim M.d NPPES

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

KENNETH KIM M.D (NPI 1922002468) is an individual pediatric critical care medicine provider in Fountain Valley, California, licensed in California (18733) and active in the NPI registry since June 2005. He is enrolled in Medicare PECOS and is a graduate of George Washington University School Of Medicine (1992).

NPPES Registry Identity

NPI1922002468
Entity TypeIndividualMale
Primary Taxonomy2080P0203X
Provider Legal NameKENNETH KIMCredential: M.D
Location Address17100 EUCLID ST., PICUFountain Valley, CA 92708
Mailing Address17100 Euclid St., PicuFountain Valley, CA 92708 · (714) 966-7253 · Fax (714) 966-3354
Phone(714) 966-7253
Fax(714) 966-3354
Sole ProprietorNo
Medical School CMSGeorge Washington University School Of MedicineGraduated 1992
Enumeration DateJune 13, 2005
Last NPPES UpdateAugust 19, 2025
NPPES CertifiedAugust 19, 2025
✔ NPI 1922002468 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatrics · Pediatric Critical Care MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080P0203X
License✔ Licensed in CA · 18733
Definition
A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists.
Also ListedPediatricsTaxonomy 208000000X · License G077876 (CA)
17100 EUCLID ST., Fountain Valley, CA 92708
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kenneth Kim M.d is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID143555466
PECOS Enrollment IDI20190709002430
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.

Medicare Billing Reassignment

Medicare enrollment records show Kenneth Kim reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Pokroy Medical Group Of Nevada, Ltd.
226 mi
Neonatal-Perinatal Medicine
653 N TOWN CENTER DR STE 112
Las Vegas, NV 89144
  • Reassigned Medicare billing, Nevada enrollment
  • 150 clinicians in this Medicare group
NPI 1992809412 (702) 733-0981

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

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.

ZACHARIA REDA M.D.
Pediatrics (Pediatric Pulmonology)
17100 EUCLID ST., PICU
FOUNTAIN VALLEY, CA 92708
Orange County (714) 966-7253
DR. WILLIAM G. PERKINS M.D.
Pediatrics (Pediatric Critical Care Medicine)
17100 EUCLID ST., PICU
FOUNTAIN VALLEY, CA 92708
Orange County (714) 966-7253

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 Kenneth Kim's NPI number?

The NPI number for Kenneth Kim is 1922002468. It was assigned to this individual provider in the NPPES registry on June 13, 2005.

Where is Kenneth Kim located?

Kenneth Kim practices at 17100 Euclid St. Picu, Fountain Valley, CA 92708. The listed phone number is (714) 966-7253.

What is Kenneth Kim's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Critical Care Medicine, with taxonomy code 2080P0203X.

Is Kenneth Kim enrolled in Medicare?

Yes. Kenneth Kim is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kenneth Kim's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kenneth Kim reassigns Medicare benefits to Pokroy Medical Group Of Nevada, Ltd. (Las Vegas, NV). 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 Kenneth 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 Kenneth Kim was last updated on August 19, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.