Audrey Kim, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

61519 Issued in CA

Practice address

930 Sunnyslope Rd Ste B3
Hollister, CA 95023-5616

Phone

(831) 647-4627

Fax

(831) 637-7017

NPI assigned

Jul 30, 2012

Last updated

Sep 29, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: anguyen@direct.westerndental.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kim Dental Corporation

  dba Family Dental and Implant Center

  • Dental Clinic/Center
  • Hollister, CA
  • NPI 1922773365
  NPD Authorized official

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

{
    "created_epoch": "1343606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632873600000",
    "number": "1053667832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17775 CALLE GRANADA",
            "city": "MORGAN HILL",
            "state": "CA",
            "postal_code": "950372992",
            "telephone_number": "716-374-3273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 SUNNYSLOPE RD STE B3",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950235616",
            "telephone_number": "831-647-4627",
            "fax_number": "831-637-7017"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "426 Loumena Ln",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "951112243",
            "country_code": "US",
            "telephone_number": "716-374-3273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "AUDREY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-30",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "61519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth P. Jiang MD, Inc (Cornerstone Health)
• Kenneth P. Jiang, M.D., Inc.
• Dilshad M. Kheraj, D.O.
• Khoi Le, D.D.S Inc.
• Kim Dental Corporation (Family Dental and Implant Center)
• Sheila Kimura, MFT
• Dustin Kinsley
• Kathleen Sue Kirk
• Lauren Jean Kissner, M.D.
• Joseph Lee Klapper, M.D.

• Dentist in Hollister, CA
• Providers in Hollister, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; 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.