NPIMap

Organization Active NPI

Ko and Nam DDS a Professional Dental Corporation

  • Endodontics
  • Upland, CA
National Provider Identifier
1134819717
Registry record updated May 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
Legal business name
KO AND NAM DDS A PROFESSIONAL DENTAL CORPORATION
Practice address
1317 W Foothill Blvd Ste 138
Upland, CA 91786-3693
Phone
(909) 303-3449
NPI assigned
May 9, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2023

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

Authorized official

Name
Moon-Hee KoNPI 1033402508
Title
DDS
Phone
(213) 700-9020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223E0200X Primary

Addresses

Primary practice location

1317 W Foothill Blvd Ste 138
Upland, CA 91786-3693

Mailing address

3553 Grayburn Rd
Pasadena, CA 91107-4628

National Provider Directory

National Provider Directory

Locations

1317 W Foothill Blvd
Ste 138
Upland, CA 91786
Phone (909) 303-3449

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1683590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683590400000",
    "number": "1134819717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3553 GRAYBURN RD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911074628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 W FOOTHILL BLVD STE 138",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917863693",
            "telephone_number": "909-303-3449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KO AND NAM DDS A PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-09",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-08",
        "status": "A",
        "authorized_official_last_name": "KO",
        "authorized_official_first_name": "MOON-HEE",
        "authorized_official_title_or_position": "DDS",
        "authorized_official_telephone_number": "213-700-9020"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; 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.