Active NPI
Ha Eun Kim, DDS
- Dentist
- Moreno Valley, CA
National Provider Identifier
1003531104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 108243
- Practice address
- 12625 Frederick St Ste F4
Moreno Valley, CA 92553-5234 - Phone
- (951) 697-7750
- NPI assigned
- Oct 11, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 108243 | CA | Primary |
Addresses
Primary practice location
12625 Frederick St Ste F4
Moreno Valley, CA 92553-5234
Mailing address
11770 Randolph CT
Loma Linda, CA 92354-4188
Phone (909) 488-6723
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 108243 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sang G Shin, DDS, Inc. | Dentist | Past | Accepting new patients |
| Hyun J. Shin, | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Moreno Valley, CA
- NPI 1275865222
-
- Dentist
- Moreno Valley, CA
- NPI 1821425232
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1665446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665446400000",
"number": "1003531104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11770 RANDOLPH CT",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923544188",
"telephone_number": "909-488-6723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12625 FREDERICK ST STE F4",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925535234",
"telephone_number": "951-697-7750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "HA",
"middle_name": "EUN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-11",
"last_updated": "2022-10-11",
"certification_date": "2022-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "108243",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moreno Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.