Healthcare Provider Details

I. General information

NPI: 1760998736
Provider Name (Legal Business Name): INNOVATIVE FOOT AND ANKLE CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8283 GROVE AVE STE 106
RANCHO CUCAMONGA CA
91730-3139
US

IV. Provider business mailing address

8283 GROVE AVE STE 106
RANCHO CUCAMONGA CA
91730-3139
US

V. Phone/Fax

Practice location:
  • Phone: 909-500-3500
  • Fax: 909-530-3007
Mailing address:
  • Phone: 909-500-3500
  • Fax: 909-530-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERT KIM
Title or Position: OWNER
Credential: DPM
Phone: 909-500-3500