Kimball Dental Group of Mission Valley, PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

KIMBALL DENTAL GROUP OF MISSION VALLEY, PC

Doing business as

Rio Vista Family Dentistry

Practice address

8590 Rio San Diego Dr Ste 110
San Diego, CA 92108-5597

Phone

(619) 299-1122

NPI assigned

Sep 20, 2019

Last updated

Sep 20, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Twyla M Pardon

Title

Regional Director of Operations

Phone

(714) 420-0952

Specialties & licenses 1

Addresses

Other names 1

• Rio Vista Family Dentistry Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Patricia Campillo Peralta

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • San Diego, CA
  • NPI 1801294301
  NPD
• Joy Bonifacio Lockwood, DDS

  • General Practice Dentistry
  • San Diego, CA
  • NPI 1376633487
  NPD (past)
• Raquel R Reyes, D.D.S.

  • General Practice Dentistry
  • San Diego, CA
  • NPI 1922196757
  NPD (past)

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

{
    "created_epoch": "1568937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568937600000",
    "number": "1073164141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31972 COAST HWY STE 300",
            "city": "LAGUNA BEACH",
            "state": "CA",
            "postal_code": "926516762",
            "telephone_number": "714-420-0952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8590 RIO SAN DIEGO DR STE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921085597",
            "telephone_number": "619-299-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBALL DENTAL GROUP OF MISSION VALLEY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-20",
        "last_updated": "2019-09-20",
        "status": "A",
        "authorized_official_last_name": "PARDON",
        "authorized_official_first_name": "TWYLA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "REGIONAL DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "714-420-0952"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rio Vista Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Youngmi P Kim, N.P.
• Youngseob Kim, DMD
• Youngsun Kim, DPT, OCS, SCS, MTC
• Yung Shin Kim, D.D.S
• Yunmi Kim
• Amy L Kimball, M.D.
• Dale W Kimball, O.D.
• Emily Kimball
• Kara Kimball
• Michael Patton Kimball, M.D.

• Dentist in San Diego, CA
• Providers in San Diego, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2019; 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.