Erica Tammy Kim, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DDS100080 Issued in CA

Practice address

18531 Roscoe Blvd Ste 207
Northridge, CA 91324-5968

Phone

(818) 772-1800

NPI assigned

Jan 29, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Susan Jarakian DDS Inc

  • Pediatric Dentistry
  • Northridge, CA
  • NPI 1215265640
  NPD (past)

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

{
    "created_epoch": "1454025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577318400000",
    "number": "1083072540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18531 ROSCOE BLVD STE 207",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913245968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18531 ROSCOE BLVD STE 207",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913245968",
            "telephone_number": "818-772-1800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13320 Riverside Dr",
            "address_purpose": "LOCATION",
            "city": "Sherman Oaks",
            "state": "CA",
            "postal_code": "914232502",
            "country_code": "US",
            "telephone_number": "818-789-3844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "ERICA",
        "middle_name": "TAMMY",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-29",
        "last_updated": "2019-12-26",
        "certification_date": "2019-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "DDS100080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Northridge",
            "affiliation": "N",
            "address_1": "18531 Roscoe Blvd Ste 207",
            "city": "Northridge",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913245968",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Annie Grace Kim, MS, OTR/L
• Cheol Kim
• CHI Hye Kim
• Chris Hyon Kim, D,O,
• Christine Kim
• Gene S Kim, PHARM.D.
• Grace Kim, NURSE PRACTITIONER
• Jin Kook Kim, LAC
• Joo Kim, ACUPUNCTURIST
• Misun Michelle Kim, PHARM.D

• Pediatric Dentistry in Northridge, CA
• Providers in Northridge, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 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.