Active NPI
Namie Kong, DMD
- Pediatric Dentistry
- Carson, CA
National Provider Identifier
1013297795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 64577
- Practice address
- 20700 Avalon Blvd
Carson, CA 90746-3701 - Phone
- (323) 564-2444
- NPI assigned
- Aug 25, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 64577 | CA | Primary |
| General Practice Dentistry | 1223G0001X | 27271 | TX |
Addresses
Primary practice location
20700 Avalon Blvd
Carson, CA 90746-3701
Mailing address
20700 Avalon Blvd
Carson, CA 90746-3701
Phone (323) 564-2444
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27271 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448236800000",
"number": "1013297795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20700 AVALON BLVD",
"city": "CARSON",
"state": "CA",
"postal_code": "907463701",
"telephone_number": "323-564-2444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20700 AVALON BLVD",
"city": "CARSON",
"state": "CA",
"postal_code": "907463701",
"telephone_number": "323-564-2444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KONG",
"first_name": "NAMIE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-25",
"last_updated": "2015-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "64577",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "27271",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carson, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.