Active NPI
Ji Eun Kim
- Dentist
- Seattle, WA
National Provider Identifier
1114871738
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 112085
- Practice address
- 1959 NE Pacific St # B-338
Seattle, WA 98195-7446 - Phone
- (206) 543-5787
- NPI assigned
- Feb 21, 2026
- Sex
- Unspecified or another gender identity
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 112085 | CA | Primary |
Addresses
Primary practice location
1959 NE Pacific St # B-338
Seattle, WA 98195-7446
Mailing address
3974 Pennsylvania Ave Unit 102
La Crescenta, CA 91214-3794
Phone (818) 934-2915
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 112085 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1771632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1771632000000",
"number": "1114871738",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3974 PENNSYLVANIA AVE UNIT 102",
"city": "LA CRESCENTA",
"state": "CA",
"postal_code": "912143794",
"telephone_number": "818-934-2915"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1959 NE PACIFIC ST # B-338",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981957446",
"telephone_number": "206-543-5787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JI EUN",
"sole_proprietor": "NO",
"sex": "X",
"enumeration_date": "2026-02-21",
"last_updated": "2026-02-21",
"certification_date": "2026-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "112085",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.