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Clement Changbum Kim

Internal Medicine

Allopathic & Osteopathic Physicians

26357 Mcbean Pkwy, Valencia, CA 91355-4488

PECOS Enrollment

This provider is enrolled in PECOS as CLEMENT KIM.

Based on the most recent information from CMS, provider Clement Changbum Kim is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 10:04 AM.

Profile Details

Provider ID
1558474262
Provider Type
Individual
Full Name
Kim, Clement Changbum
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
8/16/2006
Last Updated
12/15/2021

Contact Information

Practice Location

26357 Mcbean Pkwy, Valencia, CA 91355-4488

(661) 222-2658

(661) 222-2663

Mailing Location

PO Box 9602, Mission Hills, CA 91346-9602

(818) 837-5637

(818) 837-5589

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License A64821 California
Code 208000000X	Description Pediatrics Allopathic & Osteopathic Physicians	License A64821 California

Provider Identifiers

ID	Description	Issuer
ID 00A648210	Description Medicaid	Issuer Unlisted California

Clement Changbum Kim

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Melkonyan, Anna

Truong, Kevin Le

Nafisi, Arash

Basiratmand, Siamak

Reddy, Sadwika Garlapati

Karanam, Deepthi

Clark, Kerry R

Pv Healthcare Corp

Melkonian, Arineh Sahaghian

Hogan, Tiffany Aline