NPIMap

Organization Active NPI

Keon-Jung Kim Professional Dental Corporation

  • Dental Clinic/Center
  • Carlsbad, CA
National Provider Identifier
1114132107
Registry record updated Aug 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
47919 Issued in CA
Legal business name
KEON-JUNG KIM PROFESSIONAL DENTAL CORPORATION
Practice address
3257 Camino de Los Coches
#303
Carlsbad, CA 92009-8966
Phone
(760) 479-9876
Fax
(760) 479-0028
NPI assigned
May 11, 2007
Organization subpart
Yes
Parent organization
KEON-JUNG KIM DENTAL CORP.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 23, 2007

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

Authorized official

Name
Keon-Jung Kim, D.D.S.
Title
Owner
Phone
(760) 479-9876

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 47919 CA Primary

Addresses

Primary practice location

3257 Camino de Los Coches
#303
Carlsbad, CA 92009-8966

Mailing address

3257 Camino de Los Coches
#303
Carlsbad, CA 92009-8966
Phone (760) 479-9876

National Provider Directory

National Provider Directory
Part of
Keon-Jung Kim Dental Corp

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187827200000",
    "number": "1114132107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3257 CAMINO DE LOS COCHES",
            "address_2": "#303",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920098966",
            "telephone_number": "760-479-9876",
            "fax_number": "760-479-0028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3257 CAMINO DE LOS COCHES",
            "address_2": "#303",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920098966",
            "telephone_number": "760-479-9876",
            "fax_number": "760-479-0028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEON-JUNG KIM PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KEON-JUNG KIM DENTAL CORP.",
        "enumeration_date": "2007-05-11",
        "last_updated": "2007-08-23",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "KEON-JUNG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-479-9876",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "47919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carlsbad, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2007; 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.