Miracle Mile Comprehensive Dental Center

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5015001 Issued in CA

Legal business name

MIRACLE MILE COMPREHENSIVE DENTAL CENTER

Practice address

5455 Wilshire Blvd
Suite # 850
Los Angeles, CA 90036-4201

Phone

(323) 930-4600

Fax

(323) 930-4604

NPI assigned

Aug 29, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Jang Wook Kim, D.D.S.NPI 1801920921

Title

Ceo

Phone

(323) 930-4600

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 2

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

• Jang Wook Kim, DDS

  • Dentist
  • Los Angeles, CA
  • NPI 1801920921

  General Practice

  NPD (past) Authorized official
• Azzah Widatalla, DDS

  • Dentist
  • Los Angeles, CA
  • NPI 1316544570
  NPD (past)

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

{
    "created_epoch": "1219968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1043468267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5455 WILSHIRE BLVD",
            "address_2": "SUITE # 850",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900364201",
            "telephone_number": "323-930-4600",
            "fax_number": "323-930-4604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5455 WILSHIRE BLVD",
            "address_2": "SUITE # 850",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900364201",
            "telephone_number": "323-930-4600",
            "fax_number": "323-930-4604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRACLE MILE COMPREHENSIVE DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-29",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JANG WOOK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "323-930-4600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "5015001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D5015001",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1801920921",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Miracle Home Health Care, Inc.
• Miracle Home Health Care, Inc.
• Miracle Life Hospice, Inc
• Miracle Mile Center for Diagnostic Imaging
• Miracle Mile Community Practice
• Miracle Mile Healthcare Center LLC
• Miracle Mile Hospice Care, Inc.
• Miracle Mile Medical Center for Dermatology and Cosmetic Surgery, Inc
• Miracle Mile Medical Center, LLC
• Miracle Mile Multispecialty Group

• General Practice Dentistry in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.