NPIMap

Organization Active NPI

Jae G. Kim Professional Dental Corporation

  • General Practice Dentistry
  • Los Angeles, CA
National Provider Identifier
1043439953
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
41439 Issued in CA
Legal business name
JAE G. KIM PROFESSIONAL DENTAL CORPORATION
Practice address
2500 Wilshire Blvd
Suite 1100
Los Angeles, CA 90057-4303
Phone
(213) 385-9710
Fax
(213) 385-9343
NPI assigned
Apr 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Inwoo Yi, DDSNPI 1972723203
Title
Secretary
Phone
(213) 385-9710

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 41439 CA Primary

Addresses

Primary practice location

2500 Wilshire Blvd
Suite 1100
Los Angeles, CA 90057-4303

Mailing address

2500 Wilshire Blvd
Suite 1100
Los Angeles, CA 90057-4303
Phone (213) 385-9710

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043439953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 WILSHIRE BLVD",
            "address_2": "SUITE 1100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900574303",
            "telephone_number": "213-385-9710",
            "fax_number": "213-385-9343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 WILSHIRE BLVD",
            "address_2": "SUITE 1100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900574303",
            "telephone_number": "213-385-9710",
            "fax_number": "213-385-9343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAE G. KIM PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "YI",
        "authorized_official_first_name": "INWOO",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "213-385-9710",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "41439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.