MR. SAM YONG KIM (NPI# 1114122645) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114122645 |
| Entity Type | Individual |
| Full Name | MR. SAM YONG KIM |
| Credential | IDC |
| Practice Address |
Box 555697 Camp Pendleton CA 92055 AE |
| Mailing Address |
9115 Dillon Dr La Mesa CA 91941-4230 |
| Practice Telephone | 6199618745 |
| Mailing Telephone | 6199618745 |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376186080 | Sam Eunwoo Kim | Physical Therapist | 1429 N 15th St Apt 2f, Philadelphia, PA 19121-4354 | 2019-10-25 |
| 1821264284 | Sam Kim | Acupuncturist | 6290 Abbotts Bridge Rd Ste 203, Johns Creek, GA 30097-1750 | 2008-05-06 |
| 1194917435 | Sam Yong Kim | Acupuncturist | 4269 W 3rd St, Los Angeles, CA 90020-3448 | 2007-08-10 |
| 1558307579 | Sam Kwang Kim | Pediatrics | 228 Roseberry St, Suite # 3, Phillipsburg, NJ 08865-1687 | 2006-06-20 |
| 1528348695 | Sam Dk Kim | Dentist | 1412 Sw 43rd St, Idc Medical Plaza, #109, Renton, WA 98057-4803 | 2011-08-22 |
| 1134364086 | Sam Kim | Occupational Therapist | 6901 N 72nd St, Omaha, NE 68122-1709 | 2008-12-06 |
| 1184776569 | Sam K. Kim | Radiology | 9961 Sierra Ave, Fontana, CA 92335-6720 | 2007-01-17 |
| 1932256559 | Sam Kim | Chiropractor | 620 Alabama St, Redlands, CA 92373-8059 | 2007-01-04 |
| 1851454615 | Sam Y Kim | Otolaryngology | 1919 Lathrop St, Ste 103, Fairbanks, AK 99701-5937 | 2006-12-19 |
| 1073540621 | Sam Y.h. Kim | Dentist | 4941 Olivehurst Ave, Olivehurst, CA 95961-4225 | 2006-06-27 |
| Street Address |
BOX 555697 |
| City | CAMP PENDLETON |
| State | CA |
| Zip Code | 92055 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235730755 | Zaccary Griffin | Military Health Care Provider | Building 4101 Stuart Mesa Rd, Camp Pendleton, CA 92055 | 2020-11-02 |
| 1194325597 | Connie Lim Good | Dental Hygienist | 14th Street Bldg 13128, Oceanside, CA 92055 | 2020-10-27 |
| 1386243327 | Leticia Isabel Alcantar | Dental Hygienist | Bldg 520448, Camp Pendleton, CA 92055 | 2020-10-21 |
| 1548869571 | Joshua Watersjackson | Specialist/Technologist | 430406 Las Pulgas, Camp Pendleton, CA 92055 | 2020-10-21 |
| 1235737164 | Tynesha Felice Calimquim | Dental Hygienist | Naval Hospital Camp Pendleton, Dental Department, 200 Mercy Circle, Oceanside, CA 92055 | 2020-10-13 |
| 1801494182 | Luis Alberto Necoechea | Military Health Care Provider | 1st Recon Bn Bas, Oceanside, CA 92055 | 2020-10-09 |
| 1689271603 | Lorena Santodomingo | Dental Hygienist | Bldg 210735 C Street, Camp Pendleton, CA 92055 | 2020-10-02 |
| 1720695984 | Douglas Thomas Duncan | Dental Assistant | 92055- 14th Strret, Oceanside, CA 92055 | 2020-09-30 |
| 1528675980 | Dora Louise Young | Dental Assistant | 92055 14th Street, Camp Pendleton, CA 92055 | 2020-09-29 |
| 1306453956 | Lynne Marie Reardon | Dental Hygienist | Bldg 310515, Camp Pendleton, CA 92055 | 2020-09-28 |
| Find all providers in zip 92055 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649879537 | David Michael Soliani | Military Health Care Provider | Bld 4101 Stuart Mesa Road, Camp Pendleton, CA 92055-5584 | 2020-10-21 |
| 1083237549 | Gavino Martin Lopez | Military Health Care Provider | 1st Marine Raider Battalion Medical, 555341, Camp Pendleton, CA 92055-5341 | 2020-05-19 |
| 1902432750 | Patrick Joseph Oshaughnessy | Military Health Care Provider | 4100377, West Marsoc Rd, Camp Pendleton, CA 92055 | 2020-03-12 |
| 1710519368 | Wayne Oliver Jaworski | Military Health Care Provider | 1st Recon Bn, Bas, 555584, Camp Pendleton, AP 92055 | 2020-02-11 |
| 1215572797 | Thomas Raphael Rojas | Military Health Care Provider | 1st Mrb, Camp Pendleton, CA 92055-5341 | 2019-11-08 |
| 1205487212 | Daniel Grant Redifer | Military Health Care Provider | 1mrb 555341, Camp Pendleton, CA 92055 | 2019-09-23 |
| 1467012294 | Jonathan Eric Heyler | Military Health Care Provider | 1st Reconnaissance Bn, Camp Pendleton, CA 92055-5584 | 2019-06-14 |
| 1700356938 | Michael Francom | Military Health Care Provider | 4100377 West Marsoc Road, Camp Pendleton, CA 92055 | 2018-11-30 |
| 1396213971 | Kirtney So Lim | Military Health Care Provider | 62 Area San Mateo Naval Clinic, Camp Pendleton, CA 92672 | 2018-11-13 |
| 1396254116 | John Edward Bohan IIi | Military Health Care Provider | 21 Area Del Mar Clinic, Nhcp Box 555191, Camp Pendleton, CA 92055 | 2017-09-25 |
| Find all providers in CAMP PENDLETON | ||||
| City | CAMP PENDLETON |
| Zip Code | 92055 |
Please comment or provide details below to improve the information on MR. SAM YONG KIM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.