Active NPI
Justin E Kim, D.D.S.
- General Practice Dentistry
- Loma Linda, CA
National Provider Identifier
1114348265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 63093
- Practice address
- 11140 Mesquite Ave
Loma Linda, CA 92354-6556 - Phone
- (408) 710-8121
- NPI assigned
- Dec 16, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 63093 | CA | Primary |
Addresses
Primary practice location
11140 Mesquite Ave
Loma Linda, CA 92354-6556
Mailing address
11140 Mesquite Ave
Loma Linda, CA 92354-6556
Phone (408) 710-8121
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150901003116 | CA | Order and Referring Only - Dentist | 1254647563 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63093 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1387152000000",
"number": "1114348265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11140 MESQUITE AVE",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923546556",
"telephone_number": "408-710-8121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11140 MESQUITE AVE",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923546556",
"telephone_number": "408-710-8121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JUSTIN",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-12-16",
"last_updated": "2013-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "63093",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.